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General NPI Number Information
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NPI Number | 1487687182
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Entity Type | Organization
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Legal Business Name | CODAC HEALTH, RECOVERY & WELLNESS, INC.
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 3100 N 1ST AVE
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City | TUCSON
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State | AZ
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Zip | 85719-2513
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Country | US
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Telephone | 520-202-1960
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Fax | 520-622-5358
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Provider Business Mailing Address
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Address Line | 1650 E FORT LOWELL RD STE 202
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City | TUCSON
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State | AZ
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Zip | 85719-2378
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Country | US
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Telephone | 520-327-4505
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Fax | 520-202-1889
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Authorized Official
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Title or Position | CEO
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Name | MR. DENNIS REGNIER
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Credential |
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Telephone | 520-327-4505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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