Provider Demographics
NPI:1578677993
Name:CARE LEVEL MANAGEMENT ARIZONA, INC
Entity Type:Organization
Organization Name:CARE LEVEL MANAGEMENT ARIZONA, INC
Other - Org Name:CARE LEVEL MANAGEMENT ARIZONA
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ST.ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-595-8180
Mailing Address - Street 1:5700 CANOGA AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6579
Mailing Address - Country:US
Mailing Address - Phone:800-377-3606
Mailing Address - Fax:818-595-8206
Practice Address - Street 1:2525 E CAMELBACK RD
Practice Address - Street 2:SUITE 940
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4219
Practice Address - Country:US
Practice Address - Phone:800-829-8133
Practice Address - Fax:818-595-8206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ107317Medicare ID - Type UnspecifiedMEDICARE NUMBER