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1790699502 NPI number — COPPER CANYON RECOVERY GROUP

NPI Number: 1790699502
Health Care Provider/Practitioner: COPPER CANYON RECOVERY GROUP

Information about “1790699502” NPI (COPPER CANYON RECOVERY GROUP) exists in 1790699502 in HTML format HTML  |  1790699502 in plain Text format TXT  |  1790699502 in PDF (Portable Document Format) PDF  |  1790699502 in an XML format XML  formats.

NPI Number : 1790699502 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1790699502",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "COPPER CANYON RECOVERY GROUP",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "201 W 4TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CASA GRANDE",
    "MailingAddressStateName": "AZ",
    "MailingAddressPostalCode": "85122-4417",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "201 W 4TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CASA GRANDE",
    "PracticeLocationAddressStateName": "AZ",
    "PracticeLocationAddressPostalCode": "85122-4417",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "520-251-0088",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/29/2026",
    "LastUpdateDate": "09/29/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "RENELLO",
    "AuthorizedOfficialFirstName": "TONY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "CONSULTANT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "480-606-8602",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "324500000X",
        "TaxonomyName": "Substance Abuse Rehabilitation Facility",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "NULL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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