| Samaria Behavioral Health Center Llc | |
|
6197 S Rural Rd Tempe AZ 85283-2909 | |
| (480) 471-8980 | |
| (480) 912-1061 |
| Full Name | Samaria Behavioral Health Center Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 6197 S Rural Rd, Tempe, Arizona |
| Authorized Official Name and Position | Benitho Louissaint (MEMBER) |
| Authorized Official Contact | 4804718980 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Samaria Behavioral Health Center Llc 6197 S Rural Rd Tempe AZ 85283-2909 Ph: (480) 471-8980 | Samaria Behavioral Health Center Llc 6197 S Rural Rd Tempe AZ 85283-2909 Ph: (480) 471-8980 |
| NPI Number | 1861099798 |
|---|---|
| Provider Enumeration Date | 10/05/2020 |
| Last Update Date | 12/13/2024 |
| Certification Date | 12/13/2024 |
| Medicare PECOS PAC ID | 3274941091 |
|---|---|
| Medicare Enrollment ID | O20210415002831 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861099798 | NPI | - | NPPES |
| Provider Name | Benitho Louissaint |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053834945 PECOS PAC ID: 6709143498 Enrollment ID: I20171205003335 |
| Provider Name | Nikkita Lee Dinnella |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306618590 PECOS PAC ID: 2264881119 Enrollment ID: I20231218001863 |
| Provider Name | Stacey Leija |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043031651 PECOS PAC ID: 1355878711 Enrollment ID: I20241224000185 |
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