| St. Sophie's, Llc | |
|
5045 E Cottontail Run Rd Paradise Valley AZ 85253-3316 | |
| (701) 365-4488 | |
| (701) 365-4127 |
| Full Name | St. Sophie's, Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 5045 E Cottontail Run Rd, Paradise Valley, Arizona |
| Authorized Official Name and Position | Emmet Michael Kenney (PRESIDENT/CEO) |
| Authorized Official Contact | 7013654488 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Sophie's, Llc 3120z 25th St S # 340 Fargo ND 58103-5054 Ph: (701) 365-4488 | St. Sophie's, Llc 5045 E Cottontail Run Rd Paradise Valley AZ 85253-3316 Ph: (701) 365-4488 |
| NPI Number | 1336415942 |
|---|---|
| Provider Enumeration Date | 03/28/2012 |
| Last Update Date | 03/28/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336415942 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 7174 (North Dakota) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 7174 (North Dakota) | Secondary |
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