Provider Demographics
NPI:1104068691
Name:MAGELLAN HEALTH SERVICES OF ARIZONA, INC
Entity type:Organization
Organization Name:MAGELLAN HEALTH SERVICES OF ARIZONA, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-797-8345
Mailing Address - Street 1:4129 E VAN BUREN ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-6939
Mailing Address - Country:US
Mailing Address - Phone:602-273-2300
Mailing Address - Fax:
Practice Address - Street 1:3227 E BELL RD
Practice Address - Street 2:SUITE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2700
Practice Address - Country:US
Practice Address - Phone:602-273-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH3310251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management