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NPI Code Detail

MEDICARE: THE POTTER'S HOUSE SUBSTANCE ABUSE CENTER

MEDICARE: THE POTTER'S HOUSE SUBSTANCE ABUSE CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2251S00000XCommunity/Behavioral Health AgencyBH3520AZ
3261QR0400XRehabilitation Clinic/CenterLISAC-10784AZ
4251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11225147960OTHERAZNPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225147960
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE POTTER'S HOUSE SUBSTANCE ABUSE CENTER
Provider Business Mailing Address
First Line : 1717 W NORTHERN AVE STE 101
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-5400
Country : US
Telephone Number : 602-254-9701
Fax Number : 602-252-0830
Provider Business Practice Location Address
First Line : 1717 W NORTHERN AVE STE 101
Second Line :
City : PHOENIX
State : AZ
Zip : 85021-5400
Country : US
Telephone Number : 602-254-9701
Fax Number : 602-252-0830
Authorized Official
Title or Position : VICE PRESIDENT
Name : MS. SHEENA ROSETTE JONES
Credential :
Telephone Number : 602-254-9701
Provider Enumeration Date : 08/29/2006
Last Update Date : 10/22/2019

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Directions to “THE POTTER'S HOUSE SUBSTANCE ABUSE CENTER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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