Organization
CAME TO PASS SOBER LIVING RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GRACIELA DEL MORAL (OWNER/MANAGER)
(928) 864-9702
Entity
Organization
Contact information
Practice address
1072 E OLD CANYON CT, FLAGSTAFF, AZ 86001-5924
(928) 864-9702
Mailing address
1072 E OLD CANYON CT, FLAGSTAFF, AZ 86001-5924
(928) 864-9702
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
BH5453
AZ
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
BH5453
AZ
324500000X
Substance Abuse Rehabilitation Facility
BH5453
AZ
Other
Enumeration date
06/19/2018
Last updated
06/19/2018
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