Provider Demographics
NPI:1790463263
Name:TUSA AZAH BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:TUSA AZAH BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:AZAH
Authorized Official - Last Name:ANAGHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-673-3666
Mailing Address - Street 1:450 W ADAMSVILLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-8582
Mailing Address - Country:US
Mailing Address - Phone:919-673-3666
Mailing Address - Fax:
Practice Address - Street 1:450 W ADAMSVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-8582
Practice Address - Country:US
Practice Address - Phone:919-673-3666
Practice Address - Fax:877-683-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)