Provider Demographics
NPI:1306870910
Name:ST LUKES BEHAVIORAL HOSPITAL LP
Entity type:Organization
Organization Name:ST LUKES BEHAVIORAL HOSPITAL LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:JAHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-251-8546
Mailing Address - Street 1:1800 E VAN BUREN ST
Mailing Address - Street 2:ATTN: BILLING
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-3742
Mailing Address - Country:US
Mailing Address - Phone:602-251-8535
Mailing Address - Fax:602-251-8707
Practice Address - Street 1:1800 E VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-3742
Practice Address - Country:US
Practice Address - Phone:602-251-8642
Practice Address - Fax:602-251-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ500670Medicaid
AZ034013Medicare Oscar/Certification
Z115323Medicare PIN