Organization
SEMPER FIDELIS BEHAVIORAL HEALTH CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NASSON NATHAN (ADMINISTRATOR)
(480) 430-5491
Entity
Organization
Contact information
Practice address
111 N DUPONT CIR UNIT 337, PHOENIX, AZ 85034-1847
(860) 308-3823
Mailing address
111 N DUPONT CIR UNIT 337, PHOENIX, AZ 85034-1847
(860) 308-3823
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Enumeration date
06/09/2020
Last updated
06/29/2020
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