Healthcare Provider Details

I. General information

NPI: 1043963440
Provider Name (Legal Business Name): CAMELBACK RECOVERY TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4527 N 16TH ST STE 200
PHOENIX AZ
85016-5354
US

IV. Provider business mailing address

4340 E INDIAN SCHOOL RD STE 21-237
PHOENIX AZ
85018-5392
US

V. Phone/Fax

Practice location:
  • Phone: 760-835-7562
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER NEWMAN
Title or Position: COO
Credential:
Phone: 760-835-7562