Provider Demographics
NPI:1427741438
Name:TANDEM BEHAVIOR HEALTH CARE
Entity type:Organization
Organization Name:TANDEM BEHAVIOR HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTABARUKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-247-1824
Mailing Address - Street 1:2970 E SANTA ROSA DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-1448
Mailing Address - Country:US
Mailing Address - Phone:469-247-1824
Mailing Address - Fax:
Practice Address - Street 1:832 W BASELINE RD STE 12
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-9522
Practice Address - Country:US
Practice Address - Phone:469-247-1824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty