Provider Demographics
NPI:1184701906
Name:INTENSIVE TREATMENT SYSTEMS LLC
Entity type:Organization
Organization Name:INTENSIVE TREATMENT SYSTEMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-996-0110
Mailing Address - Street 1:19401 N CAVE CREEK RD
Mailing Address - Street 2:18 ADMINISTRATIVE OFFICE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1825
Mailing Address - Country:US
Mailing Address - Phone:602-996-0105
Mailing Address - Fax:602-996-1915
Practice Address - Street 1:4136 N 75TH AVE STE 116
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-3100
Practice Address - Country:US
Practice Address - Phone:623-247-1234
Practice Address - Fax:623-247-4231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
AZBH2604251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ946791OtherAHCCCS
AZAZ10080MOtherFDA
AZAZ10080MOtherFDA