| Sage Memorial Hospital Behavioral Health Clinic | |
|
Highway 264 And 191 Salsbury Hall Sage Memorial Hospital Campus Ganado AZ 86505 | |
| (928) 755-4500 | |
| (928) 755-4747 |
| Full Name | Sage Memorial Hospital Behavioral Health Clinic |
|---|---|
| Speciality | Social Worker |
| Location | Highway 264 And 191, Ganado, Arizona |
| Authorized Official Name and Position | Ahmad R. Razaghi (CEO) |
| Authorized Official Contact | 9287554500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sage Memorial Hospital Behavioral Health Clinic Po Box 457 Ganado AZ 86505-0457 Ph: (928) 755-4500 | Sage Memorial Hospital Behavioral Health Clinic Highway 264 And 191 Salsbury Hall Sage Memorial Hospital Campus Ganado AZ 86505 Ph: (928) 755-4500 |
| NPI Number | 1407026651 |
|---|---|
| Provider Enumeration Date | 03/04/2008 |
| Last Update Date | 03/04/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407026651 | NPI | - | NPPES |
| 942757 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 5168T (Arizona) | Secondary |
| 101Y00000X | Counselor | 13084 (Arizona) | Secondary |
| 104100000X | Social Worker | 11643 (Arizona) | Primary |