Westside Behavioral Health LLC

Primary specialty

Assisted Living Facility (Behavioral Disturbances)Taxonomy code 3104A0630X

Legal business name

WESTSIDE BEHAVIORAL HEALTH LLC

Practice address

853 Pala Mesa Dr
Kingman, AZ 86409-3923

Phone

(928) 279-2661

NPI assigned

Dec 30, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Tii Mambilla, MD

Title

Ceo

Phone

(928) 279-2661

Specialties & licenses 4

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1735516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735516800000",
    "number": "1043028673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "853 PALA MESA DR",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093923",
            "telephone_number": "928-279-2661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "853 PALA MESA DR",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093923",
            "telephone_number": "928-279-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-30",
        "last_updated": "2024-12-30",
        "certification_date": "2024-12-29",
        "status": "A",
        "authorized_official_last_name": "MAMBILLA",
        "authorized_official_first_name": "TII",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-279-2661",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John A Weidner, D.O.
• Dawn Michelle Weiler, COTA/L
• West Kingman Pharmacy LLC
• West Kingman Pharmacy, LLC
• West Transportation LLC (yellow & lightning taxi)
• White Cliffs Counseling PLLC
• Jill A White, M.S. CCC-SLP
• Renee L White, LCSW
• Ryan Widdison, O.D.
• William Wilkins, D.C.

• Assisted Living Facility (Behavioral Disturbances) in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Assisted Living Facility (Behavioral Disturbances) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.