Provider Demographics
NPI:1427701937
Name:NUPHASE HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:NUPHASE HEALTH SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:QIANA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:MAYBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-747-6522
Mailing Address - Street 1:14613 E DESERT VISTA TRL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85262-7826
Mailing Address - Country:US
Mailing Address - Phone:717-747-6522
Mailing Address - Fax:
Practice Address - Street 1:4225 W GLENDALE AVE STE A102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8195
Practice Address - Country:US
Practice Address - Phone:717-747-6522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ164883Medicaid
AZCSLG11865OtherAZ COUNSELING FACILITY LICENSE