Organization
ARROWHEAD LODGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH CHANCE D.DIV. (CEO/PRESIDENT)
(928) 227-2448
Entity
Organization
Contact information
Practice address
5113 W ARROWHEAD DR, PRESCOTT, AZ 86305-7304
(928) 227-2448
(928) 441-1516
Mailing address
PO BOX 10835, PRESCOTT, AZ 86304-0835
(928) 227-2448
(928) 441-1516
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH-3965
AZ
Other
Enumeration date
09/20/2013
Last updated
09/20/2013
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