CODAC HEALTH, RECOVERY & WELLNESS, INC. (NPI# 1801207642) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801207642 |
| Entity Type | Organization |
| Organization Name | CODAC HEALTH, RECOVERY & WELLNESS, INC. |
| Other Organization Name | CODAC AT BROADWAY |
| Practice Address |
3130 E Broadway Blvd Tucson AZ 85716-5863 |
| Mailing Address |
1650 E Fort Lowell Rd Ste 202 Tucson AZ 85719-2374 |
| Practice Telephone | 5203274505 |
| Practice Fax Number | 5202021889 |
| Mailing Telephone | 5203274505 |
| Mailing Fax Number | 5202021889 |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2015-09-25 |
| Authorized Official Name | MR. DENNIS REGNIER (CEO) |
| Authorized Official Telephone | 5203274505 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0850X |
Clinic/Center Specialization: Adult Mental Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 968685 | 05 |
| Other Name | Type Code |
|---|---|
| CODAC at Broadway | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699226068 | Codac Health, Recovery & Wellness, Inc. | Community Based Residential Treatment Facility, Mental Illness | 2482 N Palo Verde Ave, Tucson, AZ 85716-2548 | 2016-10-20 |
| 1255881355 | Codac Health, Recovery & Wellness, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4801 E Helen St, Tucson, AZ 85712-4717 | 2016-10-12 |
| 1518358530 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 1600 N Country Club Rd, Tucson, AZ 85716-3119 | 2015-02-12 |
| 1750797692 | Codac Health, Recovery & Wellness, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4758 E Andrew St, Tucson, AZ 85711-6427 | 2014-07-10 |
| 1952685414 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 1080 S 10th Ave, Tucson, AZ 85701-2907 | 2011-10-03 |
| 1467475434 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 502 N Silverbell Rd, Tucson, AZ 85745-2626 | 2006-07-25 |
| 1730570102 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 101 W Irvington Rd, Office 3 A, Tucson, AZ 85714-3050 | 2015-02-06 |
| 1376931493 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 1075 E Fort Lowell Rd, Tucson, AZ 85719-2159 | 2014-12-23 |
| 1235569328 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 2001 W Orange Grove Rd, Ste 416, Tucson, AZ 85704-1139 | 2013-11-26 |
| 1174862007 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 630 N Alvernon Way, Ste 161, Tucson, AZ 85711-1843 | 2013-02-13 |
| Street Address |
3130 E BROADWAY BLVD |
| City | TUCSON |
| State | AZ |
| Zip Code | 85716-5863 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245534114 | Letty Fields | Counselor | 3130 E Broadway Blvd, Tucson, AZ 85716-5863 | 2011-01-06 |
| 1598257537 | Jay Edwin Seppanen | Counselor | 3130 E Broadway Blvd, Tucson, AZ 85716-5863 | 2018-06-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063065043 | Kristi Watson Mdpc | Clinic/Center | Hodges Eye Care and Surgical Location, 1502 N. Tucson Blvd, Tucson, AZ 85716 | 2019-07-19 |
| 1639731326 | Leigh-anne Andre | Social Worker | 1135 N. Jones Blvd, Tucson, AZ 85716 | 2019-07-02 |
| 1053802462 | Thomas Scott Mcvean | Technician, Pathology | 718 N Richey Blvd, Tucson, AZ 85716 | 2018-05-21 |
| 1063923787 | Intermountain Health Center, Inc. | Clinic/Center | 3815 E. Monte Vista, Apt. 1101, Tuscon, AZ 85716 | 2017-10-20 |
| 1992224729 | Rocio Fonseca | Counselor | 1014 N Country Club, Tucson, AZ 85716 | 2017-09-13 |
| 1548784473 | Adrian Linda Fait | Speech-Language Pathologist | Child & Family Resources, Inc., 2800 E. Broadway Blvd, Tucson, AZ 85716 | 2017-08-02 |
| 1447701867 | Katheryn Fredman | Counselor | 3830 E. Bellevue St., Tucson, AZ 85716 | 2016-10-20 |
| 1396114211 | Craig Stark | Internal Medicine | 2978 E Greenlee St, Tucson, AZ 85716 | 2015-09-21 |
| 1598142283 | Layla Carol Bradley | Nurse Practitioner | 3832 E. Speedway, Minute Clinic, Tucson, AZ 85716 | 2015-05-01 |
| 1134547813 | Maeve Shaughnessy | Counselor | 2921 E Fort Lowell Rd Ste 207, Tucson, AZ 85716 | 2014-03-31 |
| Find all providers in zip 85716 | ||||
| Taxonomy Code | 261QM0850X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adult Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093240020 | Cottonwood Tucson Outpatient Services | Clinic/Center | 4110 W Sweetwater Dr Bldg 16, Tucson, AZ 85745-9348 | 2017-04-27 |
| 1760916407 | Grace Home Assisted Living 1 | Clinic/Center | 2301 S Quail Hollow Dr, Tucson, AZ 85710-7986 | 2017-04-19 |
| 1730534405 | New Horizons Behavioral Health Services Inc | Clinic/Center | 5849 E 5th St, Tucson, AZ 85711-2403 | 2016-04-29 |
| 1205293487 | Neuropco LLC | Clinic/Center | 4061 E Via Del Vireo, Tucson, AZ 85718-3311 | 2016-01-20 |
| 1265806186 | Banner -- University Medicine Crisis Response Center LLC | Clinic/Center | 2802 E District St Fl 1, Tucson, AZ 85714-2081 | 2015-11-16 |
| 1457755183 | Barrabee Therapy LLC | Clinic/Center | 2299 W. Camino San Acacio, Tucson, AZ 85741-3696 | 2014-10-09 |
| 1487984720 | Desert Milagros, LLC | Clinic/Center | 3438 N. Country Club Road, Tucson, AZ 85716-1257 | 2010-01-09 |
| 1588814685 | Valerie M. Kading, Np, P.l.l.c | Clinic/Center | 6969 E Sunrise Dr, Suite 202, Tucson, AZ 85750-0720 | 2008-09-24 |
| 1770742959 | University Physicians Healthcare | Clinic/Center | 2800 E. Ajo Way, Tucson, AZ 85713-3204 | 2008-06-03 |
| 1033319751 | Codac Behavioral Health Services of Pima County, Inc. | Clinic/Center | 721 N 4th Ave, Tucson, AZ 85705-8446 | 2007-07-20 |
| Find all providers in TUCSON | ||||
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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.