| Organization Name: | USA MEDDAC, RWBACH |
| NPI Number: | 1881779353 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JOSEPH A BUBALA (CLINICAL DIRECTOR, ASAP) |
| Mailing Address: | 2240 Winrow Ave Fort Huachuca |
| State: | AZ US |
| Postal Code: | 85613 |
| Phone Number: | 5205332071 |
| Fax Number: | |
| NPI Enumeration Date: | 10/25/2006 |
| NPI Last Update Date: | 07/19/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0405X |
| License Number: | LISAC 1029 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AZ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation, Substance Use Disorder |
| Taxonomy Definition: | |