Organization
THE POTTER'S HOUSE SUBSTANCE ABUSE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHEENA ROSETTE JONES (VICE PRESIDENT)
(602) 254-9701
Entity
Organization
Contact information
Practice address
1717 W NORTHERN AVE STE 101, PHOENIX, AZ 85021-5400
(602) 254-9701
(602) 252-0830
Mailing address
1717 W NORTHERN AVE STE 101, PHOENIX, AZ 85021-5400
(602) 254-9701
(602) 252-0830
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
251S00000X
Community/Behavioral Health Agency
BH3520
AZ
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
LISAC-10784
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004477
—
AZ
01
—
1225147960
NPI
AZ
Enumeration date
08/29/2006
Last updated
10/22/2019
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