Provider Demographics
NPI:1326215955
Name:SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICES INC
Other - Org Name:SEABHS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTS & CREDENTIALING ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ESTELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:520-838-5513
Mailing Address - Street 1:611 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-6718
Mailing Address - Country:US
Mailing Address - Phone:520-586-0800
Mailing Address - Fax:520-586-0116
Practice Address - Street 1:4755 CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635
Practice Address - Country:US
Practice Address - Phone:520-458-3932
Practice Address - Fax:520-458-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3043251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ336159Medicaid
AZOTC-6892OtherADHS LICENSING