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General NPI Number Information
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NPI Number | 1710420286
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Entity Type | Organization
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Legal Business Name | ACADIA HEALTHCARE INC
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Dates
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Enumeration Date | 11/30/2016
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 2699 E ANDY DEVINE SUITE B
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City | KINGMAN
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State | AZ
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Zip | 86401
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Country | UM
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Telephone | 928-753-7107
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Fax |
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Provider Business Mailing Address
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Address Line | 410 RIATA VALLEY RD
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City | KINGMAN
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State | AZ
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Zip | 86409-2976
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Country | US
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Telephone | 928-530-4546
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERI LYNN BROCK
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Credential | DC
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Telephone | 928-530-4546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP7850
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License Number State | AZ
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