Provider Demographics
NPI:1194003350
Name:MARANA BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:MARANA BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-682-4111
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-682-4570
Practice Address - Street 1:13395 N MARANA MAIN ST
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85653-7008
Practice Address - Country:US
Practice Address - Phone:520-682-1091
Practice Address - Fax:520-682-4132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARANA HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-21
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3894261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)