Provider Demographics
NPI:1467699777
Name:DESERT WINDS BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:DESERT WINDS BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IGNA
Authorized Official - Suffix:
Authorized Official - Credentials:PROGRAM DIRECTOR/ADM
Authorized Official - Phone:623-879-0168
Mailing Address - Street 1:6127 W. WESTWIND DR.
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85310
Mailing Address - Country:US
Mailing Address - Phone:623-879-0168
Mailing Address - Fax:623-879-0168
Practice Address - Street 1:6127 W. WESTWIND DR.
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85310
Practice Address - Country:US
Practice Address - Phone:623-879-0168
Practice Address - Fax:623-879-0168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3092251B00000X, 251K00000X, 251S00000X, 320800000X, 385HR2055X
AZBH-3092320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ486880OtherAHCCCS