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General NPI Number Information
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NPI Number | 1487180998
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Entity Type | Organization
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Legal Business Name | COTTONWOOD DE TUCSON, INC.
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 4110 W SWEETWATER DR
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City | TUCSON
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State | AZ
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Zip | 85745-9348
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Country | US
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Telephone | 520-743-0411
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Fax | 520-743-7991
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Provider Business Mailing Address
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Address Line | 4110 W SWEETWATER DR
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City | TUCSON
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State | AZ
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Zip | 85745-9348
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Country | US
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Telephone | 520-743-0411
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Fax | 520-743-7991
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Authorized Official
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Title or Position | CEO
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Name | MR. BRIAN C WELCH
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Credential |
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Telephone | 520-743-0411
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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 | BH4473
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License Number State | AZ
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