Provider Demographics
NPI:1679645691
Name:ACADIA HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:ACADIA HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:623-583-6570
Mailing Address - Street 1:13260 N 94TH DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4240
Mailing Address - Country:US
Mailing Address - Phone:623-583-6570
Mailing Address - Fax:623-583-6571
Practice Address - Street 1:13260 N 94TH DR
Practice Address - Street 2:SUITE 205
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4240
Practice Address - Country:US
Practice Address - Phone:623-583-6570
Practice Address - Fax:623-583-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7394111N00000X
AZ5702111N00000X
AZ0520171100000X
AZ2420204C00000X
207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ76994OtherMEDICARE ID-PIN
AZZ76994Medicare PIN