Organization
GREENGATE INTENSIVE, LLC
Active
Organization
GREENGATE INTENSIVE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DIGUISEPPE (DIRECTOR)
(818) 429-2188
Entity
Organization
Contact information
Practice address
1560 E ROUTE 66, FLAGSTAFF, AZ 86001-4821
(928) 814-2008
Mailing address
1560 E ROUTE 66, FLAGSTAFF, AZ 86001-4821
(928) 814-2008
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH-3440
AZ
Other
Enumeration date
03/22/2010
Last updated
03/22/2010
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