Provider Demographics
NPI:1508942723
Name:INTENSIVE TREATMENT SYSTEMS LLC
Entity Type:Organization
Organization Name:INTENSIVE TREATMENT SYSTEMS LLC
Other - Org Name:ITS MAIN CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-996-0110
Mailing Address - Street 1:19401 N CAVE CREEK ROAD
Mailing Address - Street 2:ADMINISTRATIVE OFFICE #18
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1825
Mailing Address - Country:US
Mailing Address - Phone:602-996-0105
Mailing Address - Fax:602-996-1915
Practice Address - Street 1:651 W COOLIDGE STREET
Practice Address - Street 2:ITS MAIN CLINIC
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-2718
Practice Address - Country:US
Practice Address - Phone:602-248-0550
Practice Address - Fax:602-248-0557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
AZBH 2473251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ872095OtherAHCCCS
AZAZ10049MOtherFDA
AZAZ10049MOtherFDA