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General NPI Number Information
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NPI Number | 1104373364
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Entity Type | Organization
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Legal Business Name | ARIZONA REHAB CAMPUS, LLC
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 04/04/2019
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Provider Practice Location Address
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Address Line | 6944 E TANQUE VERDE RD
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City | TUCSON
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State | AZ
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Zip | 85715
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Country | US
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Telephone | 844-272-5608
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Fax |
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Provider Business Mailing Address
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Address Line | 6944 E TANQUE VERDE RD
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City | TUCSON
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State | AZ
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Zip | 85715-5308
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Country | US
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Telephone | 520-526-1028
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Fax | 520-777-5752
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Authorized Official
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Title or Position | CLAIMS MGR
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Name | MS. NICOLE WILLIAMS
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Credential |
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Telephone | 520-526-1028
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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 | IFBH8264
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | IFBH8264
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License Number State | AZ
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