Provider Demographics
NPI: | 1174281554 |
---|---|
Name: | SCL COLLEGE OF NURSING |
Entity Type: | Organization |
Organization Name: | SCL COLLEGE OF NURSING |
Other - Org Name: | CAMELBACK KIDS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ELANGE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NATHAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DR |
Authorized Official - Phone: | 480-215-9056 |
Mailing Address - Street 1: | 5062 N 19TH AVE STE 100 |
Mailing Address - Street 2: | |
Mailing Address - City: | PHOENIX |
Mailing Address - State: | AZ |
Mailing Address - Zip Code: | 85015-3225 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 602-855-0002 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7517 W SHUMWAY FARM RD |
Practice Address - Street 2: | |
Practice Address - City: | LAVEEN |
Practice Address - State: | AZ |
Practice Address - Zip Code: | 85339-7089 |
Practice Address - Country: | US |
Practice Address - Phone: | 480-215-9056 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-12-02 |
Last Update Date: | 2022-07-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | |
No | 251B00000X | Agencies | Case Management | |
No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |