Provider Demographics
NPI:1811073059
Name:INTENSIVE TREATMENT SYSTEMS LLC
Entity type:Organization
Organization Name:INTENSIVE TREATMENT SYSTEMS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-996-0110
Mailing Address - Street 1:19401 N CAVE CREEK RD
Mailing Address - Street 2:18 ADMINISTRATIVE OFFICE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85024-1825
Mailing Address - Country:US
Mailing Address - Phone:602-996-0105
Mailing Address - Fax:602-996-1915
Practice Address - Street 1:19401 N CAVE CREEK RD
Practice Address - Street 2:18 ITS NORTH CLINIC
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85024-1825
Practice Address - Country:US
Practice Address - Phone:602-996-0099
Practice Address - Fax:602-996-1915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208D00000X
AZBH 2623251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ10081MOtherFDA
AZ955023OtherAHCCCS
AZ955023OtherAHCCCS