Provider Demographics
NPI:1194087031
Name:MOUNTAINTOP BEHAVIORAL HEALTH SERVICES LLC
Entity type:Organization
Organization Name:MOUNTAINTOP BEHAVIORAL HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUGBENGA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TEPEDE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:623-363-6408
Mailing Address - Street 1:3838 W DUNBAR DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-6112
Mailing Address - Country:US
Mailing Address - Phone:602-237-2820
Mailing Address - Fax:888-843-7281
Practice Address - Street 1:3838 W DUNBAR DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-6112
Practice Address - Country:US
Practice Address - Phone:602-237-2820
Practice Address - Fax:888-843-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4024320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities