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Organization
SOUTH MOUNTAIN HOLISTIC CARE
Active
Organization
SOUTH MOUNTAIN HOLISTIC CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. STEPHANIE LYNN BRIGHAM (EXECUTIVE DIRECTOR)
(602) 565-5909
Entity
Organization
Contact information
Practice address
3219 W OLNEY AVE, LAVEEN, AZ 85339-1783
(602) 565-5909
Mailing address
3219 W OLNEY AVE, LAVEEN, AZ 85339
(602) 565-5909
Taxonomy
Speciality
Code
Description
License number
State
310500000X
Mental Illness Intermediate Care Facility
Primary
BH4914
AZ
Other
Enumeration date
08/22/2016
Last updated
08/22/2016
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