Healthcare Provider Details

I. General information

NPI: 1679800106
Provider Name (Legal Business Name): WESTCARE ARIZONA I, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 11/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 RIO VISTA DR
BULLHEAD CITY AZ
86442-7229
US

IV. Provider business mailing address

821 HANCOCK RD STE 2
BULLHEAD CITY AZ
86442-5034
US

V. Phone/Fax

Practice location:
  • Phone: 928-758-0603
  • Fax: 928-758-0609
Mailing address:
  • Phone: 928-763-1945
  • Fax: 928-763-5157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberBH-3423
License Number StateAZ

VIII. Authorized Official

Name: MS. TRACY STEVENS
Title or Position: AREA DIRECTOR
Credential: MA
Phone: 928-763-1945