Provider Demographics
NPI:1598291304
Name:PINKHEALTH, LLC
Entity Type:Organization
Organization Name:PINKHEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-442-3834
Mailing Address - Street 1:12725 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE E 101
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-9520
Mailing Address - Country:US
Mailing Address - Phone:480-442-3834
Mailing Address - Fax:623-243-5751
Practice Address - Street 1:12725 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE E 101
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9520
Practice Address - Country:US
Practice Address - Phone:480-442-3834
Practice Address - Fax:623-243-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TH0004X
AZ3312225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealthGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty