Organization
CENTRO DE AMISTAD, INCORPORADO
Active
Parent organization
CENTRO DE AMISTAD, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTRO DE AMISTAD, INC.
Authorized official
MRS. RITA MONROY (PRESIDENT AND CEO)
(602) 393-3840
Entity
Organization
Contact information
Practice address
460 N MESA DR STE 115, MESA, AZ 85201-5974
(480) 833-0227
(480) 655-1382
Mailing address
2923 N 33RD AVE, PHOENIX, AZ 85017-5201
(602) 393-3840
(602) 393-3842
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH-2632
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1062003
VO BILLING NUMBER
AZ
01
—
116906
AHCCCS PROVIDER #
AZ
01
—
600252351
MAGELLAN MIS#
AZ
01
—
A000173
MHS VENDOR NO.
AZ
01
—
BH-2632
AZ BH LICENSE NO
AZ
01
—
BH-3610
AZ BH LINENCE #
AZ
Enumeration date
11/13/2006
Last updated
03/08/2011
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