Provider Demographics
NPI:1770743213
Name:MAGELLAN HEALTH SERVICES
Entity type:Organization
Organization Name:MAGELLAN HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SITE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:DYSON-PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:SITE ADMINISTRATOR
Authorized Official - Phone:480-929-5100
Mailing Address - Street 1:1225 E. BROADWAY RD STE 240
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:480-929-5100
Mailing Address - Fax:480-731-1066
Practice Address - Street 1:1225 E BROADWAY RD STE 240
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-1526
Practice Address - Country:US
Practice Address - Phone:480-929-5100
Practice Address - Fax:480-731-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN087838251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health