Provider Demographics
NPI:1588447486
Name:IKAZE BEHAVIORAL CENTER LLC
Entity type:Organization
Organization Name:IKAZE BEHAVIORAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAFIA
Authorized Official - Middle Name:SANDRA
Authorized Official - Last Name:UWERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-420-9888
Mailing Address - Street 1:350 E DUNLAP AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-2914
Mailing Address - Country:US
Mailing Address - Phone:650-420-9888
Mailing Address - Fax:
Practice Address - Street 1:350 E DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2914
Practice Address - Country:US
Practice Address - Phone:650-420-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-15
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
No385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)