MEDICARE: GALLUS OUTPATIENT SERVICES OF ARIZONA LLC

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
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1558179523
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GALLUS OUTPATIENT SERVICES OF ARIZONA LLC

Provider Business Mailing Address
First Line	:	6110 E COLFAX AVENUE, UNIT 4
Second Line	:	PMB 302
City	:	DENVER
State	:	CO
Zip	:	80220
Country	:	US
Telephone Number	:	720-501-2222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 N 44TH ST STE B102
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-1587
Country	:	US
Telephone Number	:	720-501-2220
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RUSSELL MATTHEWS
Credential	:
Telephone Number	:	720-501-2222

Provider Enumeration Date	:	12/23/2024
Last Update Date	:	01/19/2026

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