Organization
DENOVA COLLABORATIVE HEALTH, LLC
Active
Other names
Denova Collaborative Health, LLC, Bayless Healthcare Group
Organization subpart
No
Provider details
NPI number
Authorized official
GRAHAM JOHNSON (CEO)
(602) 230-7373
Entity
Organization
Contact information
Practice address
3033 N CENTRAL AVE, 700, PHOENIX, AZ 85012-2809
(602) 230-7373
(602) 682-7455
Mailing address
3101 N CENTRAL AVE STE 550, PHOENIX, AZ 85012-2635
(602) 230-7373
(602) 682-7455
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
OTC8131
AZ
208000000X
Pediatrics Physician
OTC8131
AZ
2084P0800X
Psychiatry Physician
OTC8131
AZ
208D00000X
General Practice Physician
OTC8131
AZ
261QM1300X
Multi-Specialty Clinic/Center
Primary
OTC5758
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170664
—
AZ
Enumeration date
01/10/2014
Last updated
10/24/2023
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