1447946330 NPI number — THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC

Table of content: MS. JOYCINTH VIVIA JONES MA (NPI 1932433760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447946330 NPI number — THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447946330
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4293
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARIZONA CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85123-2669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-298-7301
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7910 W THOMAS RD STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85033-4837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-298-7301
Provider Business Practice Location Address Fax Number:
520-413-5944
Provider Enumeration Date:
04/13/2023

Additional Information

Authorized Official

Authorized Official Last Name:
VALENCIA
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING AND CLAIMS MANAGER
Authorized Official Telephone Number:
480-298-7301

Provider Taxonomy Codes

  • Taxonomy code: 2084P0802X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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