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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