Provider Demographics
NPI:1538334099
Name:SOUTHWEST BEHAVIORAL HEALTH SERVICE, INC
Entity type:Organization
Organization Name:SOUTHWEST BEHAVIORAL HEALTH SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-285-8338
Mailing Address - Street 1:3450 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2331
Mailing Address - Country:US
Mailing Address - Phone:602-285-8338
Mailing Address - Fax:602-268-8574
Practice Address - Street 1:1700 N 7TH AVE
Practice Address - Street 2:250
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1702
Practice Address - Country:US
Practice Address - Phone:602-233-0115
Practice Address - Fax:602-269-1872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH-2103OtherLICENSE NUMBER