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General NPI Number Information
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NPI Number | 1043994452
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Entity Type | Organization
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Legal Business Name | PHOENIX RESIDENTIAL TREATMENT CENTER
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 9312 W HAPPY VALLEY RD
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City | PEORIA
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State | AZ
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Zip | 85383-1262
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Country | US
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Telephone | 833-988-4025
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Fax |
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Provider Business Mailing Address
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Address Line | 4527 N 16TH ST STE 200
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City | PHOENIX
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State | AZ
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Zip | 85016-5354
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Country | US
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Telephone | 760-835-7562
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Fax |
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Authorized Official
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Title or Position | COO
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Name | CHRISTOPHER NEWMAN
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Credential |
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Telephone | 760-835-7562
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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