Provider Demographics
NPI:1669002903
Name:SUMMIT BEHAVIORAL HEALTH OF ARIZONA
Entity Type:Organization
Organization Name:SUMMIT BEHAVIORAL HEALTH OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:ISENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-710-7021
Mailing Address - Street 1:8183 E FLORENTINE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8481
Mailing Address - Country:US
Mailing Address - Phone:928-756-0694
Mailing Address - Fax:
Practice Address - Street 1:8183 E FLORENTINE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8481
Practice Address - Country:US
Practice Address - Phone:928-756-0694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT BEHAVIORAL HEALTH OF ARIZONA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder