Provider Demographics
NPI:1295988012
Name:CHOICES NETWORK OF ARIZONA, INC
Entity type:Organization
Organization Name:CHOICES NETWORK OF ARIZONA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKELVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-952-3400
Mailing Address - Street 1:3003 N CENTRAL AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2904
Mailing Address - Country:US
Mailing Address - Phone:602-952-3400
Mailing Address - Fax:602-952-3401
Practice Address - Street 1:5030 W MCDOWELL RD STE 16
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85035-3945
Practice Address - Country:US
Practice Address - Phone:602-278-1414
Practice Address - Fax:602-269-8410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOICES NETWORK OF ARIZONA, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-23
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ380777Medicaid
AZZ128829Medicare PIN