| Optimus Behavioral Health Llc | |
|
4600 E Washington St Phoenix AZ 85034-1903 | |
| (480) 840-4777 | |
| Not Available |
| Full Name | Optimus Behavioral Health Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4600 E Washington St, Phoenix, Arizona |
| Authorized Official Name and Position | Flora Issanda Stowater (ADMINISTRATOR) |
| Authorized Official Contact | 4808404777 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimus Behavioral Health Llc 4600 E Washington St Ste 300 Phoenix AZ 85034-1908 Ph: (480) 840-4777 | Optimus Behavioral Health Llc 4600 E Washington St Phoenix AZ 85034-1903 Ph: (480) 840-4777 |
| NPI Number | 1205507563 |
|---|---|
| Provider Enumeration Date | 09/25/2021 |
| Last Update Date | 12/06/2022 |
| Certification Date | 12/06/2022 |
| Medicare PECOS PAC ID | 9537556964 |
|---|---|
| Medicare Enrollment ID | O20220503001443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205507563 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Flora Issanda Stowater |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700274321 PECOS PAC ID: 2961813571 Enrollment ID: I20201202001632 |
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