Provider Demographics
NPI:1225584030
Name:SOJOURNER HEALTH
Entity Type:Organization
Organization Name:SOJOURNER HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNECHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, JD
Authorized Official - Phone:602-296-3337
Mailing Address - Street 1:PO BOX 20156
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85036-0156
Mailing Address - Country:US
Mailing Address - Phone:602-296-3337
Mailing Address - Fax:
Practice Address - Street 1:2224 E FILLMORE ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3815
Practice Address - Country:US
Practice Address - Phone:602-296-3337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3924103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty