Provider Demographics
NPI:1720890577
Name:CHA AZ LLC
Entity type:Organization
Organization Name:CHA AZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERGI
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMUSANELI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-808-5566
Mailing Address - Street 1:600 E ST HWY 260 STE 2
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4967
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 E ST HWY 260 STE 2
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4967
Practice Address - Country:US
Practice Address - Phone:303-808-5566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-20
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty