Provider Demographics
NPI:1023190618
Name:SPRINGBROOK INC
Entity type:Organization
Organization Name:SPRINGBROOK INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MED
Authorized Official - Phone:602-424-1838
Mailing Address - Street 1:4835 E CACTUS RD
Mailing Address - Street 2:SUITE 460
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-4191
Mailing Address - Country:US
Mailing Address - Phone:602-424-1838
Mailing Address - Fax:602-424-7879
Practice Address - Street 1:4835 E CACTUS RD
Practice Address - Street 2:SUITE 460
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-4191
Practice Address - Country:US
Practice Address - Phone:602-424-1838
Practice Address - Fax:602-424-7879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-2372320800000X
AZBH-3021320800000X
AZBH-2868251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ886658Medicaid