Organization
THE RIVER SOURCE OUTPATIENT PEORIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN RICHARDS (DIRECTOR OF ACCOUNT MANAGEMENT)
(561) 413-9860
Entity
Organization
Contact information
Practice address
2432 W PEORIA AVE, SUITE 1227, PHOENIX, AZ 85029-4726
(623) 277-8385
Mailing address
2432 W PEORIA AVE, SUITE 1227, PHOENIX, AZ 85029-4737
(623) 277-8385
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
CSLG7631
AZ
Other
Enumeration date
04/04/2016
Last updated
04/04/2016
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