Organization Name: | THE RIVER SOURCE |
NPI Number: | 1497167480 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DARYL FERRELL (EXECUTIVE DIRECTOR) |
Mailing Address: | 950 N Arizola Rd Ste 3 Casa Grande |
State: | AZ US |
Postal Code: | 851226196 |
Phone Number: | 5208362205 |
Fax Number: | 5208361882 |
NPI Enumeration Date: | 05/24/2014 |
NPI Last Update Date: | 05/24/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | 13-1381 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |