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Main Street Diagnostic Llc
Psychiatric Hospital in Cottonwood, Arizona
NPI 1225027477

Main Street Diagnostic Llc is a Psychiatric Hospital based in Cottonwood, AZ. Main Street Diagnostic Llc practices in Cottonwood, AZ. The NPI Number for Main Street Diagnostic Llc is 1225027477 and holds a License No. BH-2492 (Arizona).

The current practice location address for Main Street Diagnostic Llc is 636 N Main St, Cottonwood, AZ and can be reached out via phone at 928-639-4440 and via fax at 928-639-3924.

Location: 636 N Main St, Cottonwood, AZ, 86326-3725
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1225027477
Provider Name
Main Street Diagnostic Llc
Credential
Provider Entity Type
Organization
Address
636 N Main St, Cottonwood, AZ, 86326-3725
Phone Number
928-639-4440
Fax Number
928-639-3924
Provider Enumeration Date
10/20/2005
Last Update Date
02/15/2025
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Provider's Legacy Identifiers
Identifier Type State Issuer
3955228 01 AZ AETNA
404204 01 AZ JCAHCO
AZ0209640 01 AZ BCBS PROV REG. #
BH-2492 01 AZ ADHS LICENSE L1 SUB ACUTE
2215360 01 AZ CIGNA PROV REG #
887317 05 AZ
100322 01 AS CENPATICO - ADULTS
institution
Provider Business Practice Location Address Details
Address
636 N Main St
City
Cottonwood
State
Arizona
Zip
86326-3725
Phone Number
928-639-4440
Fax Number
928-639-3924
person
Provider Business Mailing Address Details
Address
636 N Main St
City
Cottonwood
State
Arizona
Zip
86326-3725
Phone Number
928-639-4440
Fax Number
928-639-3924
person
Provider's Taxonomy Details 1
Type
Hospitals
Classification
Psychiatric Hospital
Speciality
-
Taxonomy
283Q00000X
License No.
BH-2492 (Arizona)
Definition
An organization including a physical plant and personnel that provides multidisciplinary diagnostic and treatment mental health services to patients requiring the safety, security, and shelter of the inpatient or partial hospitalization settings.
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