Organization
SOUTHWEST NETWORK
Active
Organization
SOUTHWEST NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMY B. HENNING (CHIEF EXECUTIVE OFFICER)
(602) 285-4340
Entity
Organization
Contact information
Practice address
460 N MESA DR, SUITE 201, MESA, AZ 85201-5973
(480) 838-5550
(480) 756-8201
Mailing address
2700 N CENTRAL AVE, SUITE 1050, PHOENIX, AZ 85004-1133
(602) 266-8402
(602) 264-0887
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
OTC6259
AZ
251S00000X
Community/Behavioral Health Agency
Primary
OTC6259
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
515610
—
AZ
01
—
Z127516
MEDICARE PTAN
AZ
Enumeration date
11/24/2009
Last updated
08/29/2016
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