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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