Provider Demographics
NPI:1336971894
Name:MAJESTIC BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:MAJESTIC BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SHAFIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAKOOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-641-3460
Mailing Address - Street 1:2720 E THOMAS RD STE 150C
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-8237
Mailing Address - Country:US
Mailing Address - Phone:800-641-3460
Mailing Address - Fax:
Practice Address - Street 1:2720 E THOMAS RD STE 150C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8237
Practice Address - Country:US
Practice Address - Phone:800-641-3460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)