Organization
WESTSIDE BEHAVIORAL HEALTH LLC
Active
Organization
WESTSIDE BEHAVIORAL HEALTH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TII MAMBILLA MD (CEO)
(928) 279-2661
Entity
Organization
Contact information
Practice address
853 PALA MESA DR, KINGMAN, AZ 86409-3923
(928) 279-2661
Mailing address
853 PALA MESA DR, KINGMAN, AZ 86409-3923
(928) 279-2661
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
Primary
—
—
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
12/30/2024
Last updated
12/30/2024
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up