Provider Demographics
NPI:1164744736
Name:AURORA BEHAVIORAL HEALTHCARE - TEMPE, LLC
Entity Type:Organization
Organization Name:AURORA BEHAVIORAL HEALTHCARE - TEMPE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:K
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-905-5091
Mailing Address - Street 1:6350 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2857
Mailing Address - Country:US
Mailing Address - Phone:480-345-5410
Mailing Address - Fax:480-345-5450
Practice Address - Street 1:6350 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2857
Practice Address - Country:US
Practice Address - Phone:480-345-5410
Practice Address - Fax:480-345-5450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGNATURE HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-23
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBHSH-35352084P0800X
283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric Hospital
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ673684Medicaid
AZ034028Medicare Oscar/Certification