Provider Demographics
NPI:1518451251
Name:ADVANCED BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:DIQUARTO
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:775-233-5082
Mailing Address - Street 1:9417 N 17TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2310
Mailing Address - Country:US
Mailing Address - Phone:520-661-2594
Mailing Address - Fax:
Practice Address - Street 1:9417 N 17TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2310
Practice Address - Country:US
Practice Address - Phone:520-661-2594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-17
Last Update Date:2018-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty