| NPI | 1821705104 |
|---|---|
| Other Name | SCOTTSDALE PROVIDENCE RESIDENTIAL |
| Doing Business As | SCOTTSDALE PROVIDENCE RESIDENTIAL CENTER |
| Entity Type | Organization |
| Authorized Contact | DANIEL JOSEPH NICHOLS Clinical Director 602-448-4055 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM1300X Clinic/Center, Multi-Specialty | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 324500000X Substance Abuse Rehabilitation Facility | |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2022-12-05 |