Provider Demographics
NPI:1265877500
Name:RESILIENT HEALTH, INC.
Entity type:Organization
Organization Name:RESILIENT HEALTH, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-995-1767
Mailing Address - Street 1:2255 W NORTHERN AVE
Mailing Address - Street 2:SUITE B100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-4936
Mailing Address - Country:US
Mailing Address - Phone:602-995-1767
Mailing Address - Fax:
Practice Address - Street 1:820 S CALIFORNIA AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-5051
Practice Address - Country:US
Practice Address - Phone:928-669-5415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-4250251K00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ808745OtherAHCCCS ID #