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General NPI Number Information
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NPI Number | 1790916583
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Entity Type | Organization
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Legal Business Name | ASAP
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 12033 AGENCY RD # 730
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City | PARKER
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State | AZ
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Zip | 85344-7718
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Country | US
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Telephone | 928-669-5243
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Fax |
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Provider Business Mailing Address
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Address Line | 3560 CHEMEHUEVI BLVD
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City | LAKE HAVASU CITY
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State | AZ
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Zip | 86406-6326
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Country | US
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Telephone | 928-846-7874
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Fax |
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Authorized Official
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Title or Position | DRUG/ALCOHOL COUNSELOR
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Name | MR. THOMAS ELDON BROWN
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Credential | CDP
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Telephone | 928-669-5243
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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 | CP00002772
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License Number State | WA
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