Arizona Wellcare LLC

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

Legal business name

ARIZONA WELLCARE LLC

Practice address

2515 E Thomas Rd Ste 16
Phoenix, AZ 85016-7946

Phone

(866) 661-3816

NPI assigned

Nov 22, 2019

Organization subpart

No

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

Authorized official

Name

Rhonda Russell

Title

Owner

Phone

(866) 661-3816

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1574380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574380800000",
    "number": "1366088585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2515 E THOMAS RD STE 16",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167946",
            "telephone_number": "866-661-3816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2515 E THOMAS RD STE 16",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850167946",
            "telephone_number": "866-661-3816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ARIZONA WELLCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-22",
        "last_updated": "2019-11-22",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "866-661-3816"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; 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.