Provider Demographics
NPI:1700998002
Name:PASADERA BEHAVIORAL HEALTH NETWORK
Entity Type:Organization
Organization Name:PASADERA BEHAVIORAL HEALTH NETWORK
Other - Org Name:PASADERA SERENE LIFE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF QM
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, RMM, ICD10CT-CM
Authorized Official - Phone:520-628-3400
Mailing Address - Street 1:2700 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-4730
Mailing Address - Country:US
Mailing Address - Phone:520-628-3400
Mailing Address - Fax:520-628-3401
Practice Address - Street 1:302 W. VENTURA ST.
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-5478
Practice Address - Country:US
Practice Address - Phone:520-620-0188
Practice Address - Fax:520-620-0197
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASADERA BEHAVIORAL HEALTH NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-3687324500000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH-3687OtherSTATE LICENSE
AZ592776Medicaid