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General NPI Number Information
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NPI Number | 1942086251
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Entity Type | Organization
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Legal Business Name | SONORAN DETOX LLC
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Dates
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Enumeration Date | 09/01/2023
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 16433 N 68TH PL
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-1500
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Country | US
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Telephone | 888-419-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 15029 N THOMPSON PEAK PARKWAY B111, #453
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-2223
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | THOMAS LEWIS
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Credential |
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Telephone | 623-216-4253
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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 |
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License Number State |
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