Organization
WOLF CREEK RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHON PHILLIP CIAMPA (CEO)
(928) 379-4075
Entity
Organization
Contact information
Practice address
1470 W GURLEY ST, PRESCOTT, AZ 86305-2855
(928) 379-4075
Mailing address
1470 W GURLEY ST, PRESCOTT, AZ 86305-2855
(928) 379-4075
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316013253
PHD. LCSW
AZ
Enumeration date
07/20/2021
Last updated
07/20/2021
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