Organization
SOUTHEASTERN ARIZONA BEHAVIORAL HEALTH SERVICE, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ESTELLA HERNANDEZ MBA (CONTRACTS & CREDENTIALING ADMIN)
(520) 838-5513
Entity
Organization
Contact information
Practice address
936 F AVE STE B, DOUGLAS, AZ 85607-2024
(520) 586-0800
Mailing address
611 W UNION ST, BENSON, AZ 85602-6718
(520) 586-0800
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
BH4382
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277449
—
AZ
01
—
OTC-8376
ADHS LICENSING
AZ
Enumeration date
07/06/2017
Last updated
06/10/2022
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