Provider Demographics
NPI: | 1134680820 |
---|---|
Name: | REFLECTION HEALTH SERVICES L.L.C. |
Entity Type: | Organization |
Organization Name: | REFLECTION HEALTH SERVICES L.L.C. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | QUANIKA |
Authorized Official - Middle Name: | SHUNTAAYE |
Authorized Official - Last Name: | SIMPSON-JACKSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MEDICAL DIRECTOR |
Authorized Official - Phone: | 602-698-8261 |
Mailing Address - Street 1: | 5060 N 19TH AVE STE 300-28 |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85015-3210 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-698-8261 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 202 E EARLL DR STE 360 |
Practice Address - Street 2: | |
Practice Address - City: | PHOENIX |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85012-2677 |
Practice Address - Country: | US |
Practice Address - Phone: | 602-698-8261 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-03-26 |
Last Update Date: | 2020-07-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
No | 251S00000X | Agencies | Community/Behavioral Health | ||
No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | ||
No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |