| Desert Bolt Behavioral Llc | |
|
42201 N 41st Dr Ste 160 Anthem AZ 85086-3803 | |
| (850) 527-0042 | |
| (480) 296-0002 |
| Full Name | Desert Bolt Behavioral Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 42201 N 41st Dr Ste 160, Anthem, Arizona |
| Authorized Official Name and Position | Valery A Nkendong (CEO) |
| Authorized Official Contact | 4805270042 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Bolt Behavioral Llc 42201 N 41st Dr Ste 160 Anthem AZ 85086-3803 Ph: (850) 527-0042 | Desert Bolt Behavioral Llc 42201 N 41st Dr Ste 160 Anthem AZ 85086-3803 Ph: (850) 527-0042 |
| NPI Number | 1649897414 |
|---|---|
| Provider Enumeration Date | 06/28/2020 |
| Last Update Date | 07/05/2021 |
| Certification Date | 07/05/2021 |
| Medicare PECOS PAC ID | 0446662241 |
|---|---|
| Medicare Enrollment ID | O20201221001409 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649897414 | NPI | - | NPPES |
| 120200727001036 | Medicaid | AZ |
| Provider Name | Valery Ayafor Nkendong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336763218 PECOS PAC ID: 8022432871 Enrollment ID: I20201221001454 |
| Provider Name | Hannah Parrish |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053027250 PECOS PAC ID: 0840665998 Enrollment ID: I20230404000548 |
| Provider Name | Michael Janson Bass |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235829201 PECOS PAC ID: 8123486495 Enrollment ID: I20230619000175 |
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