Provider Demographics
NPI:1619368917
Name:MEADOWS OUTPATIENT CENTERS, LLC
Entity Type:Organization
Organization Name:MEADOWS OUTPATIENT CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-256-3020
Mailing Address - Street 1:19820 N 7TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1694
Mailing Address - Country:US
Mailing Address - Phone:602-256-3020
Mailing Address - Fax:623-581-7624
Practice Address - Street 1:19120 N PIMA RD STE 125
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5398
Practice Address - Country:US
Practice Address - Phone:602-256-3020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEADOWS OF WICKENBURG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-09
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QR0405X
AZ324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTIN