Organization
SOUTHWEST NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY B. HENNING (CHIEF EXECUTIVE OFFICER)
(602) 285-4340
Entity
Organization
Contact information
Practice address
9051 W KELTON LN, SUITE 13, PEORIA, AZ 85382-3533
(623) 815-5700
(623) 815-5759
Mailing address
2700 N CENTRAL AVE, SUITE 1050, PHOENIX, AZ 85004-1133
(602) 266-8402
(602) 264-0887
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
OTC6188
AZ
251S00000X
Community/Behavioral Health Agency
Primary
OTC6188
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
425250
—
AZ
01
—
Z127516
MEDICARE PTAN
AZ
Enumeration date
08/22/2008
Last updated
06/03/2020
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