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General NPI Number Information
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NPI Number | 1235806738
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Entity Type | Organization
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Legal Business Name | PRESCOTT AREA RECOVERY CENTERS
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Dates
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Enumeration Date | 08/24/2021
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Last Update Date | 08/24/2021
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Provider Practice Location Address
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Address Line | 327 S PLEASANT ST
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City | PRESCOTT
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State | AZ
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Zip | 86303-4307
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Country | US
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Telephone | 877-777-5150
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Fax |
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Provider Business Mailing Address
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Address Line | 327 S PLEASANT ST
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City | PRESCOTT
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State | AZ
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Zip | 86303-4307
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Country | US
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Telephone | 877-777-5150
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. TIMOTHY P SANDERSON
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Credential | MS, LASAC
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Telephone | 480-255-0034
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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