Provider Demographics
NPI:1689246795
Name:ABSOLUTE CARE LLC
Entity Type:Organization
Organization Name:ABSOLUTE CARE LLC
Other - Org Name:ARK OF ANGEL BEHAVIORAL HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR - CNL
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLARI
Authorized Official - Suffix:
Authorized Official - Credentials:OMD, MSN, BA, RN
Authorized Official - Phone:602-888-2468
Mailing Address - Street 1:3842 E IRWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3842 E IRWIN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3852
Practice Address - Country:US
Practice Address - Phone:602-394-2689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH6716OtherARIZONA DEPARTMENT OF HEALTH SERVICES