Provider Demographics
NPI:1134549579
Name:PRIDE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:PRIDE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:PNP-BC
Authorized Official - Phone:602-326-9135
Mailing Address - Street 1:4960 S GILBERT RD STE 109
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-6023
Mailing Address - Country:US
Mailing Address - Phone:928-326-6082
Mailing Address - Fax:866-812-0853
Practice Address - Street 1:4960 S GILBERT RD STE 109
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-6023
Practice Address - Country:US
Practice Address - Phone:928-326-6082
Practice Address - Fax:866-812-0853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-24
Last Update Date:2022-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ184979OtherPTAN
AZ922548Medicaid