Provider Demographics
NPI:1275275463
Name:MERCY CENTER OF ARIZONA
Entity Type:Organization
Organization Name:MERCY CENTER OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEESHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-661-7488
Mailing Address - Street 1:20465 W DANIEL PL
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-3648
Mailing Address - Country:US
Mailing Address - Phone:480-487-2244
Mailing Address - Fax:
Practice Address - Street 1:2432 W PEORIA AVE STE 1114
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4732
Practice Address - Country:US
Practice Address - Phone:602-661-7488
Practice Address - Fax:602-661-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-08
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health