Provider Demographics
NPI:1104930130
Name:DOWNRIVER MENTAL HEALTH CLINIC PC
Entity type:Organization
Organization Name:DOWNRIVER MENTAL HEALTH CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-399-1493
Mailing Address - Street 1:4800 N SCOTTSDALE RD STE 2500
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-7630
Mailing Address - Country:US
Mailing Address - Phone:480-524-0990
Mailing Address - Fax:
Practice Address - Street 1:20500 EUREKA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6394
Practice Address - Country:US
Practice Address - Phone:734-285-8282
Practice Address - Fax:734-281-0402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI003433000 188713000OtherMAGELLAN
MI4441363OtherTEAMSTERS
7509106200OtherBCBS OF MI:MENTAL HEALTH
MIBM820042OtherMCARE
MI004241F3OtherHAP
MI101039OtherVALUE OPTIONS
511213OtherCARE CHOICES
MI4449395OtherAETNA
MIBM820042OtherMCARE
MI4441363OtherTEAMSTERS
MI========= 25509OtherCIGNA
MI=========OtherPPOM
511213OtherCARE CHOICES
MI=========OtherEIN
MI=========OtherEIN
MI=========OtherTRICARE
MI004241F3OtherHAP
0Q24542Medicare ID - Type Unspecified
MI0N56820Medicare PIN