Provider Demographics
NPI:1255940649
Name:EMPACT - SUICIDE PREVENTION CENTER
Entity type:Organization
Organization Name:EMPACT - SUICIDE PREVENTION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMIN.
Authorized Official - Prefix:
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABARCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-784-1514
Mailing Address - Street 1:618 S MADISON DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-7248
Mailing Address - Country:US
Mailing Address - Phone:480-784-1514
Mailing Address - Fax:480-967-3528
Practice Address - Street 1:108 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-1410
Practice Address - Country:US
Practice Address - Phone:480-784-1514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness