Provider Demographics
NPI:1063287480
Name:FORTUNE BEHAVIORAL HEALTH SERVICES PLLC
Entity type:Organization
Organization Name:FORTUNE BEHAVIORAL HEALTH SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:WANJIKU
Authorized Official - Last Name:NJENGA
Authorized Official - Suffix:
Authorized Official - Credentials:PHMNP
Authorized Official - Phone:157-150-2182
Mailing Address - Street 1:3334 E WOODSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-9317
Mailing Address - Country:US
Mailing Address - Phone:571-502-1822
Mailing Address - Fax:
Practice Address - Street 1:3334 E WOODSIDE WAY
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-9317
Practice Address - Country:US
Practice Address - Phone:571-502-1822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty