Provider Demographics
NPI:1609549922
Name:MONTE VISTA BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:MONTE VISTA BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANICET
Authorized Official - Middle Name:
Authorized Official - Last Name:NDAGIJIMANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-445-5832
Mailing Address - Street 1:10720 W INDIAN SCHOOL RD STE 19
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-5799
Mailing Address - Country:US
Mailing Address - Phone:520-445-5832
Mailing Address - Fax:
Practice Address - Street 1:6206 W MONTE VISTA RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-3533
Practice Address - Country:US
Practice Address - Phone:028-886-7796
Practice Address - Fax:312-610-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility