Organization
THE RIVER SOURCE IOP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW LUCHINI (INSURANCE ADMINISTRATOR)
(928) 533-4220
Entity
Organization
Contact information
Practice address
128 W PEPPER PL, MESA, AZ 85201-7317
(480) 735-8346
Mailing address
128 W PEPPER PL, MESA, AZ 85201-7317
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
11/13/2013
Last updated
03/31/2014
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