Provider Demographics
NPI:1063576924
Name:SOUTHWEST BEHAVIORAL HEALTH SERVICES INC
Entity type:Organization
Organization Name:SOUTHWEST BEHAVIORAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDE
Authorized Official - Suffix:VIII
Authorized Official - Credentials:
Authorized Official - Phone:602-257-9339
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:602-257-9339
Mailing Address - Fax:602-265-8574
Practice Address - Street 1:404 W AERO DR
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-5407
Practice Address - Country:US
Practice Address - Phone:928-468-8055
Practice Address - Fax:928-468-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
63813Medicare ID - Type UnspecifiedGROUP NUMBER