Organization
CCR INTERGRATED HEALTH
Active
Other names
N/A
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARENCE VANARD BURTON (DIRECTOR OF OPERATIONS)
(228) 383-1240
Entity
Organization
Contact information
Practice address
12268 W DELWOOD DRIVE, 3699, ARIZONA CITY, AZ 85123
(228) 383-1240
Mailing address
P.O. BOX 3699, ARIZONA CITY, AZ 85123
(228) 383-1240
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
AZ
323P00000X
Psychiatric Residential Treatment Facility
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
503218
—
AZ
Enumeration date
03/30/2015
Last updated
03/30/2015
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