Organization
CENTRO DE AMISTAD, INCORPRORADO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RITA MONROY (PRESIDENT AND CEO)
(602) 393-3840
Entity
Organization
Contact information
Practice address
8202 S AVENIDA DEL YAQUI, GUADALUPE, AZ 85283-1024
(480) 839-2926
(480) 839-9985
Mailing address
2923 N 33RD AVE, PHOENIX, AZ 85017-5201
(602) 393-3840
(602) 393-3842
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH-187
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105842
AHCCCS PROVIDER #
AZ
01
—
1062002
VALUEOPTIONS BILLING #
AZ
01
—
125826
AHCCCS - GRP BILLER
AZ
01
—
A000171
MHS VENDOR NO.
AZ
01
—
BH-187
AZ BH LICENSE #
AZ
Enumeration date
11/13/2006
Last updated
03/08/2011
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