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NPI Code Detail

MEDICARE: COTTONWOOD DE TUCSON, INC

MEDICARE: COTTONWOOD DE TUCSON, INC
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
1283Q00000XPsychiatric HospitalAZ
2324500000XSubstance Abuse Rehabilitation FacilityAZ
33245S0500XChildren's Substance Abuse Rehabilitation FacilityAZ
4283Q00000XPsychiatric HospitalBH-073AZ
5324500000XSubstance Abuse Rehabilitation FacilityBH-073AZ
63245S0500XChildren's Substance Abuse Rehabilitation FacilityBH-073AZ
7283Q00000XPsychiatric HospitalIFBH6377AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1BH073OTHERAZAZ DEPT OF HEALTH SERVICE

General Provider Information

NPI Number : 1902974934
Entity Type Code : Organization
Provider Name (Legal Business Name) : COTTONWOOD DE TUCSON, INC
Provider Business Mailing Address
First Line : 4110 W SWEETWATER DR
Second Line : BLDG 1400
City : TUCSON
State : AZ
Zip : 85745-9348
Country : US
Telephone Number : 520-743-0411
Fax Number : 520-743-7991
Provider Business Practice Location Address
First Line : 4110 W SWEETWATER DR
Second Line : BLDG 1400
City : TUCSON
State : AZ
Zip : 85745-9348
Country : US
Telephone Number : 520-743-0411
Fax Number : 520-743-7991
Authorized Official
Title or Position : CEO
Name : MR. BRIAN C WELCH
Credential :
Telephone Number : 520-743-0411
Provider Enumeration Date : 11/30/2006
Last Update Date : 05/09/2017

Similar Medicare Providers

1861592826 — DR. GAIL N SHULTZ M.D.
Practice Location Address:
4110 W SWEETWATER DR
TUCSON, AZ
85745-9348
Practice Phone: 520-743-0411
Practice Fax:
1407904105 — COTTONWOOD DE TUCSON INC
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4110 W SWEETWATER DR
TUCSON, AZ
85745-9348
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Practice Fax: 520-743-2184
1174666564 — TAB WAYNE HOYT FNP
Practice Location Address:
4110 W SWEETWATER DR
TUCSON, AZ
85745-9348
Practice Phone: 520-743-2150
Practice Fax: 520-743-2186
1003010653 — JIM SEYMOUR MD
Practice Location Address:
4110 W SWEETWATER DR
TUCSON, AZ
85745-9348
Practice Phone: 520-743-2150
Practice Fax:
1598954752 — DR. FRANCES LEE MOORE MD
Practice Location Address:
4110 SWEETWATER DR
TUCSON, AZ
85745-9348
Practice Phone: 520-743-2150
Practice Fax: 520-743-2186
1750614467 — MATTHEW CHARLES LALLY M.D.
Practice Location Address:
4110 W SWEETWATER DR
TUCSON, AZ
85745-9348
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Practice Fax:

Directions to “COTTONWOOD DE TUCSON, INC ” Practice Location

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