MOHAVE MENTAL HEALTH CLINIC INC (NPI# 1831756659) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831756659 |
| Entity Type | Organization |
| Organization Name | MOHAVE MENTAL HEALTH CLINIC INC |
| Practice Address |
1743 Sycamore Ave Kingman AZ 86409-0927 |
| Mailing Address |
3707 N Stockton Hill Rd Ste B Kingman AZ 86409-0507 |
| Practice Telephone | 9287578111 |
| Mailing Telephone | 9287578111 |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2019-05-28 |
| Authorized Official Name | JANET M RETTMANN (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 9287578111 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | ARIZONA DEPARTMENT OF HEALTH SERVICES | BH5704 | 01 |
| Other Name | Type Code |
|---|---|
| Sycamore House | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871665596 | Mohave Mental Health Clinic Inc | Clinic/Center | 915 Airway Ave Ste A, Kingman, AZ 86409-3573 | 2006-11-15 |
| 1861562423 | Mohave Mental Health Clinic Inc | Community Based Residential Treatment Facility, Mental Illness | 1080 Sheldon Ave, Kingman, AZ 86409 | 2006-11-09 |
| 1124198791 | Mohave Mental Health Clinic Inc | Community Based Residential Treatment Facility, Mental Illness | 1091 Calumet Ave, Kingman, AZ 86409-0503 | 2006-11-09 |
| 1952471518 | Mohave Mental Health Clinic Inc | Psychiatric Unit | 1741 Sycamore Avenue, Kingman, AZ 86409 | 2006-11-09 |
| 1902894272 | Mohave Mental Health Clinic Inc | Clinic/Center | 3505 Western Ave Ste A, Kingman, AZ 86409-3074 | 2005-10-11 |
| 1922275692 | Mohave Mental Health Clinic Inc | Community/Behavioral Health | 3505 Western Ave Ste A, Kingman, AZ 86409-3074 | 2008-05-13 |
| 1790861243 | Mohave Mental Health Clinic Inc | Clinic/Center | 1145 Marina Blvd, Bullhead City, AZ 86442 | 2006-10-27 |
| 1316023864 | Mohave Mental Health Clinic Inc | Clinic/Center | 2187 Swanson Ave, Lake Havasu City, AZ 86403 | 2006-10-27 |
| Street Address |
1743 SYCAMORE AVE |
| City | KINGMAN |
| State | AZ |
| Zip Code | 86409-0927 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760482327 | Cheryl Lee Burley | Nurse Practitioner | 1743 Sycamore Ave, Kingman, AZ 86409-0927 | 2005-07-26 |
| 1760883698 | Mary H Tulinnye | Registered Nurse | 1743 Sycamore Ave, Kingman, AZ 86409-0927 | 2014-09-10 |
| 1568641819 | Kathleen A. Walker | Counselor | 1743 Sycamore Ave, Kingman, AZ 86409-0927 | 2007-11-02 |
| 1821120288 | Martha Michalski Mann | Psychiatry & Neurology | 1743 Sycamore Ave, Kingman, AZ 86409-0927 | 2007-03-12 |
| 1407867294 | Laurence David Seltzer | Psychiatry & Neurology | 1743 Sycamore Ave, Kingman, AZ 86409-0927 | 2006-08-10 |
| 1326016296 | Sirpa A Tavakoli | Psychiatry & Neurology | 1743 Sycamore Ave, Kingman, AZ 86409-0927 | 2006-03-08 |
| 1770565269 | Timothy L Davis | Counselor | 1743 Sycamore Ave, Kingman, AZ 86409-0927 | 2005-11-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437695731 | Medical Laboratory Specialty, Inc | Clinical Medical Laboratory | 3636 St, Kingman, AZ 86409 | 2017-01-10 |
| 1003219007 | Premier Home Health Agency | Home Health | 3555 Western Ave, Kingman, AZ 86409 | 2014-10-03 |
| 1558774984 | Fernando Velez | Pharmacist | 2003 Roy Rogers Way, Kingman, AZ 86409 | 2014-06-03 |
| 1013227834 | Route 66 Cab Inc | Taxi | 3595 E Us Highway 66, Kingman, AZ 86409 | 2010-10-14 |
| 1740503374 | Route 66 Cab Inc. | Taxi | 3595 East Hwy 66, Kingman, AZ 86409 | 2010-03-10 |
| 1649409145 | Arizona Cvs Stores, L.L.C. | Durable Medical Equipment & Medical Supplies | 3501 Stockton Hill Rd, Kingman, AZ 86409 | 2009-07-07 |
| 1790922896 | Jack Cheng-tsung Hou | Urology | 1739 E Beverly Ave Ste 106, Kingman, AZ 86409 | 2009-01-12 |
| 1710184726 | Michele F Epstein | Internal Medicine | 3571 N Moore Street, Kingman, AZ 86409 | 2007-07-02 |
| 1013118306 | Conchita O Mercado | Dentist | 1101 Riata Valley Rd, Kingman, AZ 86409 | 2007-05-31 |
| 1366585945 | Deering Therapy Services Ltd | Occupational Therapist | 1841 Morrow Ave, Kingman, AZ 86409 | 2007-02-14 |
| Find all providers in zip 86409 | ||||
| Taxonomy Code | 320800000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment Facility, Mental Illness |
| A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689195901 | Mohave Mental Health Clinic, Inc. | Community Based Residential Treatment Facility, Mental Illness | 3745 N Diamond Dr, Kingman, AZ 86409-3328 | 2017-06-28 |
| 1861562423 | Mohave Mental Health Clinic Inc | Community Based Residential Treatment Facility, Mental Illness | 1080 Sheldon Ave, Kingman, AZ 86409 | 2006-11-09 |
| 1124198791 | Mohave Mental Health Clinic Inc | Community Based Residential Treatment Facility, Mental Illness | 1091 Calumet Ave, Kingman, AZ 86409-0503 | 2006-11-09 |
| 1770676439 | Sequelcare of Arizona, LLC | Community Based Residential Treatment Facility, Mental Illness | 3240 Hualapai Mountain Road, Kingman, AZ 86401 | 2006-10-02 |
| 1629528716 | Exclusive Certified Residential Care, LLC | Community Based Residential Treatment Facility, Mental Illness | 3744 Martingale Dr, Kingman, AZ 86409-2994 | 2016-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811598253 | Pinnacle Behavioral Health LLC | Community Based Residential Treatment Facility, Mental Illness | 45369 W Horse Mesa Rd, Maricopa, AZ 85139-9128 | 2020-11-03 |
| 1649878687 | Ayobami Noheem Agoro | Community Based Residential Treatment Facility, Mental Illness | 12362 W Joblanca Rd, Avondale, AZ 85323-3130 | 2020-10-13 |
| 1235736018 | Happy Valley Community Services LLC | Community Based Residential Treatment Facility, Mental Illness | 1106 E Cochise Dr, Phoenix, AZ 85020-1550 | 2020-10-05 |
| 1144835968 | Jfox II LLC | Community Based Residential Treatment Facility, Mental Illness | 5327 E Enrose Cir, Mesa, AZ 85205-5489 | 2020-09-09 |
| 1639782956 | Ascend Behavioral Health and Wellness,llc | Community Based Residential Treatment Facility, Mental Illness | 3308 W Desert Vista Trl, Phoenix, AZ 85083-5874 | 2020-08-26 |
| 1952913998 | Vema Corporation | Community Based Residential Treatment Facility, Mental Illness | 12701 N 79th Dr, Peoria, AZ 85381-9049 | 2020-08-20 |
| 1720698509 | Lyddia Getaweru | Community Based Residential Treatment Facility, Mental Illness | 2767 W Peggy Dr, Queen Creek, AZ 85142-6686 | 2020-08-05 |
| 1689284531 | Brain Solutions Pllc | Community Based Residential Treatment Facility, Mental Illness | 4555 S Maverick Ct, Gilbert, AZ 85297-9532 | 2020-08-05 |
| 1548879950 | C&j Care Home LLC | Community Based Residential Treatment Facility, Mental Illness | 4418 W Darrel Rd, Laveen, AZ 85339-6222 | 2020-07-31 |
| 1295353019 | Alliance Behavioral Care LLC | Community Based Residential Treatment Facility, Mental Illness | 2840 S Chaparral Blvd, Gilbert, AZ 85295-7675 | 2020-07-08 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on MOHAVE MENTAL HEALTH CLINIC INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.