Provider Demographics
NPI:1447006663
Name:REGENERATION GROVE PSYCHIATRY LLC
Entity type:Organization
Organization Name:REGENERATION GROVE PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:LLEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROVES
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:480-618-0323
Mailing Address - Street 1:865 E BASELINE RD # 1098
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-1246
Mailing Address - Country:US
Mailing Address - Phone:480-618-0323
Mailing Address - Fax:480-605-2773
Practice Address - Street 1:1038 W PECOS AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-8238
Practice Address - Country:US
Practice Address - Phone:480-618-0323
Practice Address - Fax:480-605-2773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty