Provider Demographics
NPI:1720231236
Name:CHOICES NETWORK OF ARIZONA
Entity Type:Organization
Organization Name:CHOICES NETWORK OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKELVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-952-3400
Mailing Address - Street 1:3003 N CENTRAL AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2902
Mailing Address - Country:US
Mailing Address - Phone:602-952-3400
Mailing Address - Fax:602-952-3401
Practice Address - Street 1:1616 E ROESER RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-3336
Practice Address - Country:US
Practice Address - Phone:602-323-3000
Practice Address - Fax:602-243-5390
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOICES NETWORK OF ARIZONA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ412715Medicaid
AZZ128829Medicare PIN