Healthcare Provider Details

I. General information

NPI: 1902974934
Provider Name (Legal Business Name): COTTONWOOD DE TUCSON, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 W SWEETWATER DR BLDG 1400
TUCSON AZ
85745-9348
US

IV. Provider business mailing address

4110 W SWEETWATER DR BLDG 1400
TUCSON AZ
85745-9348
US

V. Phone/Fax

Practice location:
  • Phone: 520-743-0411
  • Fax: 520-743-7991
Mailing address:
  • Phone: 520-743-0411
  • Fax: 520-743-7991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberBH-073
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberBH-073
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberBH-073
License Number StateAZ
# 7
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberIFBH6377
License Number StateAZ

VIII. Authorized Official

Name: MR. BRIAN C WELCH
Title or Position: CEO
Credential:
Phone: 520-743-0411