Organization
TERRA NOVA BEHAVIORAL HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC MARINELLI (EXECUTIVE DIRECTOR)
(928) 642-3030
Entity
Organization
Contact information
Practice address
545 S LAKEVIEW DR, PRESCOTT, AZ 86301-7655
(928) 642-3030
Mailing address
PO BOX 13146, PRESCOTT, AZ 86304-3146
(928) 642-3030
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH8369
BEHAVIORAL HEALTH RESIDENTIAL FACILITY
AZ
Enumeration date
04/11/2023
Last updated
04/11/2023
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