Provider Demographics
NPI:1598021495
Name:GILA RIVER HEALTH CARE
Entity Type:Organization
Organization Name:GILA RIVER HEALTH CARE
Other - Org Name:THWAJIK KE OUTPATIENT BEHAVIORAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GEMBERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-528-1200
Mailing Address - Street 1:17242 S. HEALTH CARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3850 N. 16TH STREET SUITE #500
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339
Practice Address - Country:US
Practice Address - Phone:520-796-3860
Practice Address - Fax:520-796-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ589093OtherAHCCCS