NPIMap

Organization Active NPI

San Tan Behavioral Health Services

  • Child Mental Illness Respite Care
  • Lakeside, AZ
National Provider Identifier
1194027847
Registry record updated Dec 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child Mental Illness Respite CareTaxonomy code 385HR2055X
License
BH3755 Issued in AZ
Legal business name
SAN TAN BEHAVIORAL HEALTH SERVICES
Practice address
655 Southlake Rd
Lakeside, AZ 85929-6768
Phone
(928) 358-1087
Fax
(480) 632-0026
NPI assigned
Dec 1, 2010
Last updated
Dec 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2010

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

Authorized official

Name
Melissa Dawn Nelson, M.A., L.P.C.
Title
Chief Clinical Officer
Phone
(480) 507-3644

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Non-emergency Medical Transport (VAN) 343900000X BH3755 AZ
Child Mental Illness Respite Care 385HR2055X BH3755 AZ Primary

Addresses

Primary practice location

655 Southlake Rd
Lakeside, AZ 85929-6768

Mailing address

2451 E Baseline Rd
Gilbert, AZ 85234-2471
Phone (480) 507-3644

Other identifiers 1

IdentifierTypeStateIssuer
308968OtherAZAHCCCS

National Provider Directory

National Provider Directory
Tax ID family
San Tan Behavioral Health SVCS7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1291161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291161600000",
    "number": "1194027847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2451 E BASELINE RD",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852342471",
            "telephone_number": "480-507-3644",
            "fax_number": "480-632-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 SOUTHLAKE RD",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859296768",
            "telephone_number": "928-358-1087",
            "fax_number": "480-632-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN TAN BEHAVIORAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-01",
        "last_updated": "2010-12-01",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "CHIEF CLINICAL OFFICER",
        "authorized_official_telephone_number": "480-507-3644",
        "authorized_official_credential": "M.A., L.P.C."
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "AZ",
            "license": "BH3755",
            "primary": false
        },
        {
            "code": "385HR2055X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Mental Illness, Child",
            "state": "AZ",
            "license": "BH3755",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "308968",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeside, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; 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.