Provider Demographics
NPI:1053524348
Name:PASADERA BEHAVIORAL HEALTH NETWORK, INC.
Entity type:Organization
Organization Name:PASADERA BEHAVIORAL HEALTH NETWORK, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF QUALITY MANAGEMENT OFFICER
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 1:2502 N. DODGE BLVD.
Practice Address - Street 2:SUITE 190
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-2675
Practice Address - Country:US
Practice Address - Phone:520-618-8600
Practice Address - Fax:520-617-1608
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASADERA BEHAVIORAL HEALTH NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC6597261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC6597OtherSTATE LICENSE
AZ848952Medicaid
AZZ181977Medicare PIN
AZBH-4374OtherARIZONA DEPARTMENT OF LICENSING