| Southeastern Arizona Behavioral Health Service, Inc | |
|
936 F Ave Ste B Douglas AZ 85607-2024 | |
| (520) 586-0800 | |
| Not Available |
| Full Name | Southeastern Arizona Behavioral Health Service, Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 936 F Ave Ste B, Douglas, Arizona |
| Authorized Official Name and Position | Estella Hernandez (CONTRACTS & CREDENTIALING ADMIN) |
| Authorized Official Contact | 5208385513 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Arizona Behavioral Health Service, Inc 611 W Union St Benson AZ 85602-6718 Ph: (520) 586-0800 | Southeastern Arizona Behavioral Health Service, Inc 936 F Ave Ste B Douglas AZ 85607-2024 Ph: (520) 586-0800 |
| NPI Number | 1932620390 |
|---|---|
| Provider Enumeration Date | 07/06/2017 |
| Last Update Date | 06/10/2022 |
| Certification Date | 06/10/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932620390 | NPI | - | NPPES |
| OTC-8376 | Other | AZ | ADHS LICENSING |
| 277449 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH4382 (Arizona) | Primary |
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