Healthcare Provider Details

I. General information

NPI: 1861505901
Provider Name (Legal Business Name): EPIDAURUS (DBA)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 E TANQUE VERDE RD
TUCSON AZ
85749-8931
US

IV. Provider business mailing address

10500 E TANQUE VERDE RD
TUCSON AZ
85749-8931
US

V. Phone/Fax

Practice location:
  • Phone: 520-749-5980
  • Fax:
Mailing address:
  • Phone: 520-749-5980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberBH-2023
License Number StateAZ

VIII. Authorized Official

Name: MR. ROD MULLEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 520-749-5980