Organization
FSL PROGRAMS
Active
Other names
ADHC - South Mountain
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ANNETTE INIGUEZ (EXEC ASST)
(602) 285-0505
Entity
Organization
Contact information
Practice address
6520 S CENTRAL AVE, PHOENIX, AZ 85042-4240
(602) 304-0355
(602) 276-4938
Mailing address
1201 E THOMAS RD, PHOENIX, AZ 85014-5734
(602) 285-1800
(602) 285-1838
Taxonomy
Speciality
Code
Description
License number
State
385H00000X
Respite Care
Primary
ADHC-039
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
572405
—
AZ
01
—
ADHC-039
ADHS LICENSE#
AZ
01
—
BH-1038
ADHS BEHAVIORAL
AZ
Enumeration date
12/27/2006
Last updated
08/22/2020
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