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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