Organization
GRACE BEHAVIORAL HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JILL GILLESPIE CPA (CHIEF FINANCIAL OFFICER)
(602) 231-0102
Entity
Organization
Contact information
Practice address
2336 E MAGNOLIA ST, PHOENIX, AZ 85034-6819
(602) 231-0102
Mailing address
2336 E MAGNOLIA ST, PHOENIX, AZ 85034-6819
(602) 231-0102
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
971764
AHCCCS ID NUMBER
AR
Enumeration date
03/12/2007
Last updated
09/03/2010
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