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Organization

DOUGLAS ARC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. GARY J CLARK (EXECUTIVE DIRECTOR)
(520) 364-7473
Entity
Organization

Contact information

Practice address
610 9TH STREET, DOUGLAS, AZ 85607
(520) 364-7473
(520) 364-2236
Mailing address
PO BOX 252, DOUGLAS, AZ 85608
(520) 364-7473
(520) 364-2236

Taxonomy

Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
704933
AHCCCS
AZ
01
CSA06ADHS0046
AZ BEHAVIORAL HEALTH SERV
AZ
Enumeration date
09/19/2006
Last updated
08/21/2007
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