Provider Demographics
NPI:1447940507
Name:MERIDIAN HEALTHCARE
Entity type:Organization
Organization Name:MERIDIAN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:NWAKAEGO
Authorized Official - Middle Name:S
Authorized Official - Last Name:OKWUOBU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-585-8039
Mailing Address - Street 1:7208 JEMATELL LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85266-1897
Mailing Address - Country:US
Mailing Address - Phone:602-585-8039
Mailing Address - Fax:
Practice Address - Street 1:2932 S CAMEL DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-9183
Practice Address - Country:US
Practice Address - Phone:602-585-8039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility