Provider Demographics
NPI:1578294153
Name:PINETOP BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:PINETOP BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYIRAKANYANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-409-6515
Mailing Address - Street 1:674 E WHITE MOUNTAIN BLVD # 5
Mailing Address - Street 2:BLVD 5
Mailing Address - City:PINETOP
Mailing Address - State:AZ
Mailing Address - Zip Code:85935
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:674 E WHITE MOUNTAIN BLVD # 5
Practice Address - Street 2:BLVD 5
Practice Address - City:PINETOP
Practice Address - State:AZ
Practice Address - Zip Code:85935
Practice Address - Country:US
Practice Address - Phone:207-409-6515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)