Provider Demographics
NPI:1114286788
Name:PASADERA BEHAVIORAL HEALTH NETWORK, INC.
Entity Type:Organization
Organization Name:PASADERA BEHAVIORAL HEALTH NETWORK, INC.
Other - Org Name:DESERT HOPE OUTPATIENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF QUALITY MANAGEMENT OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, RMM, ICD10CT-CM
Authorized Official - Phone:520-628-3400
Mailing Address - Street 1:2700 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-4730
Mailing Address - Country:US
Mailing Address - Phone:520-628-3400
Mailing Address - Fax:520-628-3401
Practice Address - Street 1:2499 E. AJO WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85713-5478
Practice Address - Country:US
Practice Address - Phone:520-618-8701
Practice Address - Fax:520-327-9817
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASADERA BEHAVIORAL HEALTH NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-16
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC6555324500000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC6555OtherSTATE LICENSE
AZ707235Medicaid
AZ707235-01Medicaid