Organization
THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC
Active
Organization
THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA LEE (FINANCE DIRECTOR)
(520) 582-4718
Entity
Organization
Contact information
Practice address
16286 S SUNLAND GIN RD, ARIZONA CITY, AZ 85123-6196
(888) 687-7332
Mailing address
PO BOX 4293, ARIZONA CITY, AZ 85123-2669
(888) 687-7332
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
496790
JOINT COMMISSION
—
01
—
IFB6615
AZDHS
AZ
01
—
OTC9325
AZDHS - GILBERT LOCATION
AZ
Enumeration date
01/20/2009
Last updated
06/14/2023
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