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Organization

SEAGLASS RECOVERY

Active
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Organization

SEAGLASS RECOVERY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ERIC ANDREWS (DIRECTOR OF QUALITY ASSURANCE)
(928) 379-3097
Entity
Organization

Contact information

Practice address
707 W GURLEY ST, PRESCOTT, AZ 86305-3621
(877) 732-6837
Mailing address
701 S SWINTON AVE APT G, DELRAY BEACH, FL 33444-2377
(877) 732-6837

Taxonomy

Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
BH5497
ARIZONA DEPARTMENT OF HEALTH SERVICES LICENSE NUMBER
AZ
Enumeration date
02/11/2019
Last updated
02/11/2019
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