| The River Source Treatment Center Casa Grande, Llc | |
|
16286 S. Sunland Gin Rd Arizona City AZ 85123-8512 | |
| (480) 298-7301 | |
| Not Available |
| Full Name | The River Source Treatment Center Casa Grande, Llc |
|---|---|
| Speciality | Psychologist - Addiction (substance Use Disorder) |
| Location | 16286 S. Sunland Gin Rd, Arizona City, Arizona |
| Authorized Official Name and Position | Tina Lee (FINANCE DIRECTOR) |
| Authorized Official Contact | 5205824718 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| The River Source Treatment Center Casa Grande, Llc Po Box 4293 Arizona City AZ 85123-2669 Ph: (480) 298-7301 | The River Source Treatment Center Casa Grande, Llc 16286 S. Sunland Gin Rd Arizona City AZ 85123-8512 Ph: (480) 298-7301 |
| NPI Number | 1568243103 |
|---|---|
| Provider Enumeration Date | 10/10/2023 |
| Last Update Date | 10/10/2023 |
| Certification Date | 10/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568243103 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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