MEDICARE: ADDICTION SERVICES, P.C

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	251S00000X	Community/Behavioral Health Agency	BH-2422	AZ

General Provider Information

NPI Number	:	1386836450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION SERVICES, P.C

Provider Business Mailing Address
First Line	:	PO BOX 31782
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85275-1782
Country	:	US
Telephone Number	:	602-291-5210
Fax Number	:	480-461-6816

Provider Business Practice Location Address
First Line	:	850 S IRONWOOD DR
Second Line	:	SUITE 108
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85220-6242
Country	:	US
Telephone Number	:	602-291-5210
Fax Number	:	480-461-6816

Authorized Official
Title or Position	:	CEO
Name	:	MS. SYLVIA GARCIA
Credential	:	MA, LISAC
Telephone Number	:	602-291-5210

Provider Enumeration Date	:	08/13/2007
Last Update Date	:	03/27/2008

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