MEDICARE: SONORAN TREATMENT CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1205612512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONORAN TREATMENT CENTER LLC

Provider Business Mailing Address
First Line	:	15029 N THOMPSON PEAK PARKWAY
Second Line	:	STE B111, #453
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-2223
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6902 E CALLE DE LAS ESTRELLAS
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85266-5776
Country	:	US
Telephone Number	:	877-749-7354
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	THOMAS LEWIS
Credential	:
Telephone Number	:	623-216-4253

Provider Enumeration Date	:	09/01/2023
Last Update Date	:	09/01/2023

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