Provider Demographics
NPI:1215022157
Name:ALEPH CENTER, P.L.L.C.
Entity Type:Organization
Organization Name:ALEPH CENTER, P.L.L.C.
Other - Org Name:ALEPH CENTER, P.L.L.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOETA-KREISLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-885-5558
Mailing Address - Street 1:6408 E TANQUE VERDE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715
Mailing Address - Country:US
Mailing Address - Phone:520-885-5558
Mailing Address - Fax:520-885-5559
Practice Address - Street 1:6408 E TANQUE VERDE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715
Practice Address - Country:US
Practice Address - Phone:520-885-5558
Practice Address - Fax:520-885-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ27189Medicare PIN