Provider Demographics
NPI:1356813091
Name:PHC AZ LLC
Entity Type:Organization
Organization Name:PHC AZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-299-7442
Mailing Address - Street 1:9318 N 95TH WAY STE A-205
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5537
Mailing Address - Country:US
Mailing Address - Phone:480-299-7442
Mailing Address - Fax:
Practice Address - Street 1:9318 N 95TH WAY STE A-205
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5537
Practice Address - Country:US
Practice Address - Phone:480-299-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty