Provider Demographics
NPI:1548079387
Name:PATCHES WEST LLC
Entity type:Organization
Organization Name:PATCHES WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-385-0430
Mailing Address - Street 1:2525 E ARIZONA BILTMORE CIR STE C138
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-2101
Mailing Address - Country:US
Mailing Address - Phone:346-826-0800
Mailing Address - Fax:346-826-0801
Practice Address - Street 1:7830 W GRAND PKWY S STE 150
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5819
Practice Address - Country:US
Practice Address - Phone:602-698-4106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical