Provider Demographics
NPI:1437463486
Name:ST. LUKES BEHAVIORAL HOSPITAL LP
Entity Type:Organization
Organization Name:ST. LUKES BEHAVIORAL HOSPITAL LP
Other - Org Name:OUTPATIENT BILLING
Other - Org Type:Other Name
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-251-8535
Mailing Address - Street 1:117 SEABOARD LN BLDG E
Mailing Address - Street 2:ATTN: IASIS CORPORATE LEGAL DEPARTMENT
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2855
Mailing Address - Country:US
Mailing Address - Phone:615-844-2747
Mailing Address - Fax:615-467-1271
Practice Address - Street 1:1800 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3742
Practice Address - Country:US
Practice Address - Phone:602-251-8535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST LUKES BEHAVIORAL HOSPITAL LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-02
Last Update Date:2020-06-25
Deactivation Date:2017-01-20
Deactivation Code:
Reactivation Date:2020-06-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ500670Medicaid
AZ500670Medicaid
034013Medicare Oscar/Certification