Provider Demographics
NPI:1356715593
Name:MOUNTAIN TOP BEHAVIORAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:MOUNTAIN TOP BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUGBENGA
Authorized Official - Middle Name:ADEDOLAPO
Authorized Official - Last Name:TEPEDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-363-6408
Mailing Address - Street 1:7319 W MALDONADO RD
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7001
Mailing Address - Country:US
Mailing Address - Phone:623-363-6408
Mailing Address - Fax:888-843-7281
Practice Address - Street 1:7319 W MALDONADO RD
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7001
Practice Address - Country:US
Practice Address - Phone:623-363-6408
Practice Address - Fax:888-843-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-27
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4710320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness