Provider Demographics
NPI:1669003067
Name:GERIATRIC PSYCHIATRY SERVICES LLC
Entity Type:Organization
Organization Name:GERIATRIC PSYCHIATRY SERVICES LLC
Other - Org Name:SANA PHYSICIANS GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-277-3424
Mailing Address - Street 1:185 S STATE ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84111-1537
Mailing Address - Country:US
Mailing Address - Phone:801-589-4033
Mailing Address - Fax:
Practice Address - Street 1:181 WHIPPLE ST
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1705
Practice Address - Country:US
Practice Address - Phone:928-277-3424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service