Provider Demographics
NPI:1396209474
Name:ENCHANTED BEHAVIORAL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ENCHANTED BEHAVIORAL HEALTHCARE, LLC
Other - Org Name:ENCHANTED TELEPSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MUNACHISO
Authorized Official - Middle Name:
Authorized Official - Last Name:IHEONUNEKWU
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:602-837-5830
Mailing Address - Street 1:20715 N PIMA ROAD
Mailing Address - Street 2:SUITE 108 #1026
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85255
Mailing Address - Country:US
Mailing Address - Phone:602-837-5830
Mailing Address - Fax:602-837-5837
Practice Address - Street 1:20715 N PIMA RD SUITE 108 #1026
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255
Practice Address - Country:US
Practice Address - Phone:602-837-5830
Practice Address - Fax:602-837-5837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-23
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health