NPIMap

Organization Active NPI

Pasadera Behavioral Health Network Dba Level II Detoxification

  • Substance Abuse Rehabilitation Facility
  • Tucson, AZ
National Provider Identifier
1780788240
Registry record updated Sep 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
BH/H-3958 Issued in AZ
Legal business name
PASADERA BEHAVIORAL HEALTH NETWORK DBA LEVEL II DETOXIFICATION
Practice address
2950 N. Dodge Blvd.
Tucson, AZ 85716-2012
Phone
(520) 628-3155
Fax
(520) 628-3158
NPI assigned
Sep 12, 2006
Last updated
Sep 19, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
COMPASS BEHAVIORAL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 19, 2014

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

Authorized official

Name
Grover Glenn, MA, LPC, LISAC, CPHQNPI 1083985469
Title
Director of QM
Phone
(520) 618-8622

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X NU
Substance Abuse Rehabilitation Facility 324500000X BH/H-3958 AZ Primary

Addresses

Primary practice location

2950 N. Dodge Blvd.
Tucson, AZ 85716-2012

Mailing address

2502 N. Dodge Blvd.
Suite 190
Tucson, AZ 85716-2675
Phone (520) 618-8622

Other identifiers 3

IdentifierTypeStateIssuer
592578MedicaidAZ
BH/H-3958OtherAZSTATE LICENSE
807745MedicaidAZ

Other names 1

  • Compass Health Care, Inc. Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Pasadera Behavioral Health Network10 organizations share this tax ID, including this one
Part of
Pasadera Behavioral Health Network

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1158019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411084800000",
    "number": "1780788240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 N. DODGE BLVD.",
            "address_2": "SUITE 190",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857162675",
            "telephone_number": "520-618-8622",
            "fax_number": "520-617-1608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 N. DODGE BLVD.",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857162012",
            "telephone_number": "520-628-3155",
            "fax_number": "520-628-3158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASADERA BEHAVIORAL HEALTH NETWORK DBA LEVEL II DETOXIFICATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMPASS BEHAVIORAL HEALTH",
        "enumeration_date": "2006-09-12",
        "last_updated": "2014-09-19",
        "status": "A",
        "authorized_official_last_name": "GLENN",
        "authorized_official_first_name": "GROVER",
        "authorized_official_title_or_position": "DIRECTOR OF QM",
        "authorized_official_telephone_number": "520-618-8622",
        "authorized_official_credential": "MA, LPC, LISAC, CPHQ"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "BH/H-3958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "592578",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "BH/H-3958",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807745",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Compass Health Care, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2014; 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.