| Clean Adventures Of Sober Living, Llc | |
|
534 Madison Ave Prescott AZ 86301-2433 | |
| (928) 443-8767 | |
| (928) 776-4781 |
| Full Name | Clean Adventures Of Sober Living, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 534 Madison Ave, Prescott, Arizona |
| Authorized Official Name and Position | Robert Carson Patton (OWNER/EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9284438767 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Clean Adventures Of Sober Living, Llc 534 Madison Ave Prescott AZ 86301-2433 Ph: (928) 443-8767 | Clean Adventures Of Sober Living, Llc 534 Madison Ave Prescott AZ 86301-2433 Ph: (928) 443-8767 |
| NPI Number | 1366764045 |
|---|---|
| Provider Enumeration Date | 02/22/2010 |
| Last Update Date | 04/21/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366764045 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | BH-3525 (Arizona) | Secondary |
| 251S00000X | Community/behavioral Health | OTC6727 (Arizona) | Primary |
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