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General NPI Number Information
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NPI Number | 1821705104
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Entity Type | Organization
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Legal Business Name | SCOTTSDALE PROVIDENCE RECOVERY CENTER
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Dates
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Enumeration Date | 11/04/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 9389 E VIA DEL SOL DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-5072
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Country | US
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Telephone | 480-284-7440
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Fax | 480-284-4178
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Provider Business Mailing Address
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Address Line | 8889 E VIA LINDA
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-5420
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Country | US
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Telephone | 480-284-7440
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Fax | 480-284-4178
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DANIEL JOSEPH NICHOLS
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Credential | LCSW
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Telephone | 602-448-4055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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Taxonomy #5
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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Taxonomy #6
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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