Organization
CCR OTC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIN BACHMAN (CFO)
(928) 671-0161
Entity
Organization
Contact information
Practice address
819 W GURLEY ST UNIT C, PRESCOTT, AZ 86305-3626
(928) 671-0161
(928) 708-9620
Mailing address
819 W GURLEY ST UNIT C, PRESCOTT, AZ 86305-3626
(928) 671-0161
(928) 708-9620
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
10486
AZ
Other
Enumeration date
10/27/2014
Last updated
10/27/2014
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