Provider Demographics
NPI:1154852747
Name:ARIZONA WEST BEHAVIORAL HEALTH INC.
Entity Type:Organization
Organization Name:ARIZONA WEST BEHAVIORAL HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ARTENTUS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-747-6119
Mailing Address - Street 1:11564 W SCHLEIFER DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGTOWN
Mailing Address - State:AZ
Mailing Address - Zip Code:85363-1675
Mailing Address - Country:US
Mailing Address - Phone:704-747-6119
Mailing Address - Fax:
Practice Address - Street 1:3001 W INDIAN SCHOOL RD STE 24
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85017-4164
Practice Address - Country:US
Practice Address - Phone:704-747-6119
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCLSG8157251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health