=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568958510
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIEWPOINT SCOTTSDALE RECOVERY CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2018
-----------------------------------------------------
Last Update Date | 07/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7807 E GREENWAY RD STE 1
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-778-5907
-----------------------------------------------------
Fax | 928-778-5908
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 702 W HILLSIDE AVE
-----------------------------------------------------
City | PRESCOTT
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86301-1913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-778-5907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPERATIONS DIRECTOR
-----------------------------------------------------
Name | MR. JOHN STEVEN BAUMGARTNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 928-778-5907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------