Provider Demographics
| NPI: | 1134680820 |
|---|---|
| Name: | REFLECTION HEALTH SERVICES L.L.C. |
| Entity type: | Organization |
| Organization Name: | REFLECTION HEALTH SERVICES L.L.C. |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | QUANIKA |
| Authorized Official - Middle Name: | SHUNTAAYE |
| Authorized Official - Last Name: | SIMPSON-JACKSON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MEDICAL DIRECTOR |
| Authorized Official - Phone: | 602-698-8261 |
| Mailing Address - Street 1: | 5060 N 19TH AVE STE 300-28 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PHOENIX |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85015-3210 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 602-698-8261 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 202 E EARLL DR STE 360 |
| Practice Address - Street 2: | |
| Practice Address - City: | PHOENIX |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85012-2677 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 602-698-8261 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-03-26 |
| Last Update Date: | 2020-07-28 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 320600000X | Residential Treatment Facilities | Residential Treatment Facility, Intellectual and/or Developmental Disabilities | ||
| No | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | Group - Multi-Specialty | |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 251B00000X | Agencies | Case Management | ||
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | ||
| No | 251S00000X | Agencies | Community/Behavioral Health | ||
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | ||
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
