Provider Demographics
NPI:1942371992
Name:TRIPLE R BEHAVIORAL HEALTH, INC.
Entity Type:Organization
Organization Name:TRIPLE R BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOCHSTRASSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-995-7474
Mailing Address - Street 1:40 E. MITCHELL DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2330
Mailing Address - Country:US
Mailing Address - Phone:602-995-7474
Mailing Address - Fax:602-973-2993
Practice Address - Street 1:2505 W BERYL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-1607
Practice Address - Country:US
Practice Address - Phone:602-262-2100
Practice Address - Fax:602-262-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3532251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ514617OtherSTATE MEDICADE PROGRAM NUMBER--AHCCCS