Provider Demographics
NPI:1407130701
Name:SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-586-0800
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:
Mailing Address - Fax:
Practice Address - Street 1:611 W UNION ST
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-6718
Practice Address - Country:US
Practice Address - Phone:520-586-0800
Practice Address - Fax:520-586-0116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3698251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH3853OtherARIZONA DEPARTMENT OF HEALTH SERVICES - LICENSING
AZBH3853OtherARIZONA DEPARTMENT OF HEALTH SERVICES - LICENSING