Healthcare Provider Details

I. General information

NPI: 1477959385
Provider Name (Legal Business Name): BLUEPRINTS THERAPEUTIC SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 E GURLEY ST
PRESCOTT AZ
86301-3309
US

IV. Provider business mailing address

PO BOX 10878
PRESCOTT AZ
86304-0878
US

V. Phone/Fax

Practice location:
  • Phone: 928-583-4878
  • Fax: 928-708-9620
Mailing address:
  • Phone: 425-295-1010
  • Fax: 928-708-9620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberOTC6880
License Number StateAZ

VIII. Authorized Official

Name: KEVIN ROSS
Title or Position: CEO
Credential:
Phone: 917-903-7445