Organization
SOVEREIGN HEALTH OF PHOENIX, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RON GIRSKIS (BUSINESS OPERATIONS SPECIALIST)
(949) 359-8273
Entity
Organization
Contact information
Practice address
111 S HEARTHSTONE WAY, CHANDLER, AZ 85226-5010
(949) 625-0376
(949) 390-9899
Mailing address
PO BOX 5705, SAN CLEMENTE, CA 92674-5705
(949) 625-0376
(949) 390-9899
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
2005211229
DE
Other
Enumeration date
10/01/2013
Last updated
10/19/2020
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