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General NPI Number Information
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NPI Number | 1962703991
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Entity Type | Organization
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Legal Business Name | PRESCOTT HOUSE INC
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 08/01/2018
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Provider Practice Location Address
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Address Line | 214 N. AZ AVE
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 928-776-8251
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Fax | 928-771-2024
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Provider Business Mailing Address
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Address Line | 214 N. AZ AVE
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City | PRESCOTT
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State | AZ
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Zip | 86301
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Country | US
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Telephone | 928-776-8251
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Fax | 928-771-2024
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Authorized Official
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Title or Position | EXECUTIVE DIR.
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Name | MR. HENRY DAYTON TURBERVILLE
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Credential |
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Telephone | 928-776-8251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | BH-264
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License Number State | AZ
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Taxonomy #2
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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 | OTC-6470
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | BH-264
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | BH-4262
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License Number State | AZ
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