Organization
GATEHOUSE THERAPEUTIC HEALTH SERVICES
Active
Organization
GATEHOUSE THERAPEUTIC HEALTH SERVICES
Active
Parent organization
TRANSITIONAL LIVING CORPORATION
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRANSITIONAL LIVING CORPORATION
Authorized official
DAN D SOURS MC, LPC (CLINICAL DIRECTOR)
(928) 668-0710
Entity
Organization
Contact information
Practice address
159 W WICKENBURG WAY, WICKENBURG, AZ 85390-2265
(928) 668-0710
(928) 684-6852
Mailing address
159 W WICKENBURG WAY, WICKENBURG, AZ 85390-2265
(928) 668-0710
(928) 684-6852
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH-2644
AZ
Other
Enumeration date
09/20/2010
Last updated
09/20/2010
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