# THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447946330
- **Authorized official:** CHRISTINA VALENCIA (BILLING AND CLAIMS MANAGER)
- **Authorized official phone:** (480) 298-7301

## Contact information

- **Practice address:** 7910 W THOMAS RD STE 103, PHOENIX, AZ 85033-4837
- **Practice address phone:** (480) 298-7301
- **Practice address fax:** (520) 413-5944
- **Mailing address:** PO BOX 4293, ARIZONA CITY, AZ 85123-2669
- **Mailing address phone:** (480) 298-7301

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0802X | Addiction Psychiatry Physician | — | NULL | Yes |
| 2084P0802X | Addiction Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/13/2023
- **Last updated:** 04/13/2023