PRESCOTT DETOX CENTER, LLC (NPI# 1417391293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417391293 |
| Entity Type | Organization |
| Organization Name | PRESCOTT DETOX CENTER, LLC |
| Practice Address |
831 Gail Gardner Way Prescott AZ 86305-1606 |
| Practice Telephone | 9284453834 |
| Practice Fax Number | 9284453649 |
| Mailing Telephone | 9284453834 |
| Mailing Fax Number | 9284453649 |
| Enumeration Date | 2013-04-23 |
| Last Update Date | 2013-04-23 |
| Authorized Official Name | DR. ROBERT ASHBY (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 4809910280 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 276400000X | Rehabilitation, Substance Use Disorder Unit | BH4207 | AZ | Hospital Units |
| Street Address |
831 GAIL GARDNER WAY |
| City | PRESCOTT |
| State | AZ |
| Zip Code | 86305-1606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811449721 | Royal Life Centers, LLC | Substance Abuse Rehabilitation Facility | 831 Gail Gardner Way, Prescott, AZ 86305-1606 | 2016-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972005395 | Granite View Adult Care Home LLC | Assisted Living Facility | 7105 Williamson Valley Road, Prescott, AZ 86305 | 2018-03-01 |
| 1215468095 | Valerie Williams | Occupational Therapist | 926 S. Hinman Dr., Prescott, AZ 86305 | 2017-03-23 |
| 1174073837 | Caspian Gleam Medical Center LLC | Clinic/Center | 3130 Stillwater Drive, Suite B, Prescott, AZ 86305 | 2016-10-06 |
| 1114388634 | Marla Beth Perkins | Speech-Language Pathologist | 3160 Stillwater Dr., Prescott, AZ 86305 | 2016-03-10 |
| 1790159853 | Michele A. Bibeau, D.d.s. | Dentist | 1058 Fair Street, Suite A, Prescott, AZ 86305 | 2015-11-30 |
| 1609264837 | Integrative Pain Centres of Prescott | Pain Medicine | 3769 Crossings Drive, Suite B, Integrative Pain Centres of Prescott, Prescott, AZ 86305 | 2014-12-22 |
| 1649697251 | Sharon Marilyn Jackson | Counselor | 3636 Crossings Drive, Prescott, AZ 86305 | 2014-03-20 |
| 1215351259 | Stefanie Maneval | Registered Nurse | 900 Iron Springs Rd, Prescott, AZ 86305 | 2014-02-11 |
| 1508207523 | Recovery In The Pines, LLC | Community/Behavioral Health | 919 12th Place #13, Prescott, AZ 86305 | 2013-07-08 |
| 1871857359 | Neal Herbert Segovia Cabaluna | Internal Medicine | 3773 Crossings Dr Ste C, Prescott, AZ 86305 | 2012-06-28 |
| Find all providers in zip 86305 | ||||
| Taxonomy Code | 276400000X |
| Grouping | Hospital Units |
| Classification | Rehabilitation, Substance Use Disorder Unit |
| A distinct part of a hospital that provides medically monitored, interdisciplinary addiction-focused treatment to patients/clients who have psychoactive substance use disorders (commonly referred to as alcohol and drug abuse or substance abuse.) |
| Notes: Source: Department of Defense Regulation 6010.8-R, Chapter 6. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215263314 | A Sober Way Home | Rehabilitation, Substance Use Disorder Unit | 609 W Gurley St, Prescott, AZ 86305-3619 | 2009-10-23 |
| 1982894036 | A Sober Way Home | Rehabilitation, Substance Use Disorder Unit | 1211 East Gurley Street, Suite 2, Prescott, AZ 86301 | 2007-07-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821616319 | Az Peace of Mind Behavioral Health Home LLC | Rehabilitation, Substance Use Disorder Unit | 15622 W Sierra St, Surprise, AZ 85379-1038 | 2020-07-10 |
| 1265849509 | Tru Recovery Solutions, LLC | Rehabilitation, Substance Use Disorder Unit | 8196 E Valley Rd, Prescott Valley, AZ 86314-9465 | 2014-07-18 |
| 1912523549 | Buena Vista Recovery, LLC | Rehabilitation, Substance Use Disorder Unit | 3033 S Arizona Ave Ste 110, Chandler, AZ 85248-2717 | 2020-06-19 |
| 1851917488 | Buena Vista Recovery, LLC | Rehabilitation, Substance Use Disorder Unit | 5151 E Pima St Ste 110, Tucson, AZ 85712-3627 | 2020-06-19 |
| 1487126686 | Fjcm Behavioral Health Care LLC | Rehabilitation, Substance Use Disorder Unit | 2710 E Valencia Dr, Phoenix, AZ 85042-7081 | 2018-12-28 |
| 1184103400 | Crossroads, Inc | Rehabilitation, Substance Use Disorder Unit | 1700 E Thomas Rd, Phoenix, AZ 85016-7605 | 2018-08-08 |
| 1457746497 | Pasadera Behavioral Health Network, Inc. | Rehabilitation, Substance Use Disorder Unit | 2502 N Dodge Blvd, Suite 190, Tucson, AZ 85716-2671 | 2015-04-06 |
| 1740550839 | Pasadera Behavioral Health Network | Rehabilitation, Substance Use Disorder Unit | 2950 N. Dodge Blvd., Tucson, AZ 85716-2012 | 2012-01-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.