Provider Demographics
| NPI: | 1336837616 |
|---|---|
| Name: | IDEAL TREATMENT CENTER LLC |
| Entity type: | Organization |
| Organization Name: | IDEAL TREATMENT CENTER LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | NURSE PRACTITIONER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | AIMEE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | UWIMANA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | DNP |
| Authorized Official - Phone: | 602-399-0134 |
| Mailing Address - Street 1: | 1717 W NORTHERN AVE STE 107 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PHOENIX |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85021-5400 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 602-612-2305 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 1717 W NORTHERN AVE STE 107 |
| Practice Address - Street 2: | |
| Practice Address - City: | PHOENIX |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85021-5400 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 602-612-2305 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2023-04-25 |
| Last Update Date: | 2025-06-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 163WP0808X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | ||
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | Group - Multi-Specialty |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
| No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Multi-Specialty |
