Provider Demographics
NPI:1558123869
Name:PELAGIO BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:PELAGIO BEHAVIORAL HEALTH, LLC
Other - Org Name:PELAGIO BEHAVIORAL HEALTH, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LOURDES
Authorized Official - Last Name:PELAGIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-516-4184
Mailing Address - Street 1:35970 W MERCED ST
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2195
Mailing Address - Country:US
Mailing Address - Phone:602-516-4184
Mailing Address - Fax:
Practice Address - Street 1:35970 W MERCED ST
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2195
Practice Address - Country:US
Practice Address - Phone:602-516-4184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251S00000XAgenciesCommunity/Behavioral Health