| Organization Name: | COMMUNITY MEDICAL SERVICES IV LLC |
| NPI Number: | 1134253842 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANDREW GRADY LEWIS (VICE PRESIDENT) |
| Mailing Address: | 3050 N Navajo Dr Suite 106 Prescott Valley |
| State: | AZ US |
| Postal Code: | 863148663 |
| Phone Number: | 9287757088 |
| Fax Number: | 9287757099 |
| NPI Enumeration Date: | 03/15/2007 |
| NPI Last Update Date: | 06/25/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |