MEDICARE: THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	320800000X	Mental Illness Community Based Residential Treatment Facility
3	324500000X	Substance Abuse Rehabilitation Facility	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	496790	OTHER		JOINT COMMISSION
2	IFB6615	OTHER	AZ	AZDHS
3	OTC9325	OTHER	AZ	AZDHS - GILBERT LOCATION

General Provider Information

NPI Number	:	1003053570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 4293
Second Line	:
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85123-2669
Country	:	US
Telephone Number	:	888-687-7332
Fax Number	:

Provider Business Practice Location Address
First Line	:	16286 S SUNLAND GIN RD
Second Line	:
City	:	ARIZONA CITY
State	:	AZ
Zip	:	85123-6196
Country	:	US
Telephone Number	:	888-687-7332
Fax Number	:

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	TINA LEE
Credential	:
Telephone Number	:	520-582-4718

Provider Enumeration Date	:	01/20/2009
Last Update Date	:	06/14/2023

Similar Medicare Providers

1780679571 — DR. CHAD GOETZ N.M.D.
Practice Location Address:

16286 SOUTH SUNLAND GIN ROAD
ARIZONA CITY, AZ
85123

Practice Phone: 520-494-8077
Practice Fax: 520-494-8081

1780693861 — DR. SAMUEL EFRAIN SANCHEZ D.O.
Practice Location Address:

13060 S SUNDLAND GIN
ARIZONA CITY, AZ
85123-1290

Practice Phone: 520-466-5774
Practice Fax: 520-494-0319

1346378346 — SANDY JANICKI LAC
Practice Location Address:

PO BOX 4467
ARIZONA CITY, AZ
85123-2637

Practice Phone: 480-532-2716
Practice Fax: 480-532-2716

1629277066 — MISS BETH-ANN GREEN-STOLTZNER AAS COTA
Practice Location Address:

8497 W. CONCORDIA DR , REHABILITATION DEPARTMENT
ARIZONA CITY, AZ
85123-2211

Practice Phone: 530-828-8874
Practice Fax:

1821286915 — GILBERT JOSEPH MONTANO FNP-BC
Practice Location Address:

14574 S SUNLAND GIN RD
ARIZONA CITY, AZ
85123

Practice Phone: 520-387-5651
Practice Fax: 520-494-0130

1326271727 — ESPERANZA
Practice Location Address:

11140 W COVE DR
ARIZONA CITY, AZ
85123-5486

Practice Phone: 520-466-8850
Practice Fax: 520-466-8851

Directions to “THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.