Provider Demographics
NPI:1043679327
Name:MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Entity Type:Organization
Organization Name:MARICOPA COUNTY SPECIAL HEALTH CARE DISTRICT
Other - Org Name:VALLEYWISE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PFS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-344-8178
Mailing Address - Street 1:PO BOX 29670
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008
Mailing Address - Country:US
Mailing Address - Phone:602-344-8178
Mailing Address - Fax:602-344-8122
Practice Address - Street 1:950 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-1506
Practice Address - Country:US
Practice Address - Phone:602-344-2520
Practice Address - Fax:602-344-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-16
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH3673261QM0850X, 261QM0855X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ189350800OtherUS DEPT OF LABOR
AZ020107Medicaid
AZ631935OtherAETNA
AZAZ0205850OtherBLUE CROSS BLUE SHIELD
AZ50005OtherEVERCARE CHOICE
AZAZ0947OtherHEALTH NET OF AZ
AZ29517OtherPHOENIX INDIAN MED CENTER
AZ030022Medicare Oscar/Certification
AZAZ0947OtherHEALTH NET OF AZ
AZ189350800OtherUS DEPT OF LABOR