Provider Demographics
NPI:1982822656
Name:TIGNEX LLC
Entity Type:Organization
Organization Name:TIGNEX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TIGNEX PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAFFIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-217-6996
Mailing Address - Street 1:2521 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-1571
Mailing Address - Country:US
Mailing Address - Phone:602-276-4800
Mailing Address - Fax:602-232-2411
Practice Address - Street 1:2521 E WOOD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-1571
Practice Address - Country:US
Practice Address - Phone:602-276-4800
Practice Address - Fax:602-232-2411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-2765320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ177981Medicaid
AZBH-2765OtherAZ BEHAVIORAL HTH LIC. #