Healthcare Provider Details

I. General information

NPI: 1609064823
Provider Name (Legal Business Name): CR RESORTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 E ROCKCLIFF RD
TUCSON AZ
85750-9733
US

IV. Provider business mailing address

8600 E ROCKCLIFF RD
TUCSON AZ
85750-9733
US

V. Phone/Fax

Practice location:
  • Phone: 520-749-9655
  • Fax: 520-239-8515
Mailing address:
  • Phone: 520-749-9655
  • Fax: 520-239-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOTC1976
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOTC8497
License Number StateAZ

VIII. Authorized Official

Name: HENRY DITTMER
Title or Position: SVP - AUTHORIZED SIGNATORY
Credential:
Phone: 520-749-9655