Organization
CENTRO DE AMISTAD, INCORPORADO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RITA MONROY (PRESIDENT AND CEO)
(480) 839-2926
Entity
Organization
Contact information
Practice address
2923 N 33RD AVE, PHOENIX, AZ 85017-5201
(602) 393-3840
(602) 393-3842
Mailing address
8202 S AVENIDA DEL YAQUI, GUADALUPE, AZ 85283-1024
(480) 839-2926
(480) 839-9985
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH-3759
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1062007
VO BILLING NUMBER
AZ
01
—
600252357
MAGELLAN MIS#
AZ
01
—
957409
AHCCCS PROVIDER NO.
AZ
01
—
A004334
MHS VENDOR NO.
AZ
01
—
BH-2504
AZ BH LICENSE NO.
AZ
Enumeration date
11/13/2006
Last updated
12/07/2010
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