Basic Information
| Provider Information | |||||||||
| NPI: | 1942371992 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRIPLE R BEHAVIORAL HEALTH, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 E. MITCHELL DR. | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6029957474 | ||||||||
| FaxNumber: | 6029732993 | ||||||||
| Practice Location | |||||||||
| Address1: | 2505 W BERYL AVE | ||||||||
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| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850211607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022622100 | ||||||||
| FaxNumber: | 6022622111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 06/09/2010 | ||||||||
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| AuthorizedOfficialLastName: | HOCHSTRASSER | ||||||||
| AuthorizedOfficialFirstName: | WAYNE | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT, CEO | ||||||||
| AuthorizedOfficialTelephone: | 6029957474 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | BH-3532 | AZ | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 514617 | 01 | AZ | STATE MEDICADE PROGRAM NUMBER--AHCCCS | OTHER |