| Providencia | |
|
3602 W Thomas Rd Phoenix AZ 85019-4442 | |
| (602) 455-4626 | |
| (602) 455-4624 |
| Full Name | Providencia |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 3602 W Thomas Rd, Phoenix, Arizona |
| Authorized Official Name and Position | David Hedgcock (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 6024554626 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providencia 620 N Craycroft Rd Tucson AZ 85711-1448 Ph: (520) 747-6676 | Providencia 3602 W Thomas Rd Phoenix AZ 85019-4442 Ph: (602) 455-4626 |
| NPI Number | 1588764427 |
|---|---|
| Provider Enumeration Date | 09/22/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588764427 | NPI | - | NPPES |
| 796021 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | BH-2200 (Arizona) | Primary |
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