Provider Demographics
NPI:1083916035
Name:SAN TAN BEHAVIORAL HEALTH SVCS
Entity Type:Organization
Organization Name:SAN TAN BEHAVIORAL HEALTH SVCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:ARBOGAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-773-2384
Mailing Address - Street 1:2451 E BASELINE ROAD
Mailing Address - Street 2:STE 430
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234
Mailing Address - Country:US
Mailing Address - Phone:480-507-3644
Mailing Address - Fax:480-632-0026
Practice Address - Street 1:9648 E. JACOB CIRCLE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209
Practice Address - Country:US
Practice Address - Phone:480-588-7731
Practice Address - Fax:480-632-0026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN TAN BEHAVIORAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-24
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10764101YM0800X
343900000X
AZBH-3658385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1225206444Medicare PIN