Organization
THE RIVER SOURCE
Active
Organization
THE RIVER SOURCE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARYL FERRELL (EXECUTIVE DIRECTOR)
(520) 836-2205
Entity
Organization
Contact information
Practice address
950 N ARIZOLA RD STE 3, CASA GRANDE, AZ 85122-6196
(520) 836-2205
(520) 836-1882
Mailing address
950 N ARIZOLA RD STE 3, CASA GRANDE, AZ 85122-6196
(520) 836-2205
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
13-1381
AZ
Other
Enumeration date
05/24/2014
Last updated
05/24/2014
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