Healthcare Provider Details

I. General information

NPI: 1811567886
Provider Name (Legal Business Name): NAZCARE - SERENITY CIRCLE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 10/17/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 E CHERRY ST
COTTONWOOD AZ
86326-3458
US

IV. Provider business mailing address

8128 E STATE ROUTE 69 STE 201
PRESCOTT VALLEY AZ
86314-9459
US

V. Phone/Fax

Practice location:
  • Phone: 928-634-1168
  • Fax:
Mailing address:
  • Phone: 928-442-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: GREG BILLI
Title or Position: CEO
Credential:
Phone: 928-442-9205