Provider Demographics
NPI:1124713995
Name:AXEL BEHAVIORAL HEALTH SYSTEM LLC
Entity type:Organization
Organization Name:AXEL BEHAVIORAL HEALTH SYSTEM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARLSON
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMINANG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:480-516-8103
Mailing Address - Street 1:20148 N DONITHAN WAY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-2428
Mailing Address - Country:US
Mailing Address - Phone:480-516-8103
Mailing Address - Fax:
Practice Address - Street 1:20148 N DONITHAN WAY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-2428
Practice Address - Country:US
Practice Address - Phone:480-516-8103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility