Healthcare Provider Details

I. General information

NPI: 1235657461
Provider Name (Legal Business Name): ARIZONA REHAB CAMPUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6944 E TANQUE VERDE RD
TUCSON AZ
85715
US

IV. Provider business mailing address

6944 E TANQUE VERDE RD
TUCSON AZ
85715-5308
US

V. Phone/Fax

Practice location:
  • Phone: 623-326-1055
  • Fax: 480-659-1598
Mailing address:
  • Phone: 520-526-1028
  • Fax: 520-777-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License NumberOTC8336
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberOTC8336
License Number StateAZ

VIII. Authorized Official

Name: MS. NICOLE WILLIAMS
Title or Position: CLAIMS MGR
Credential:
Phone: 520-526-1028