Organization
TREATMENT ASSESSMENT SCREENING CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATRICE SHANNON HICKMAN (DIRECTOR OF PRGRM. DVLPMT.)
(602) 254-7328
Entity
Organization
Contact information
Practice address
2302 N 7TH ST, PHOENIX, AZ 85006-1602
(602) 368-4610
(602) 688-6496
Mailing address
4016 N BLACK CANYON HWY, PHOENIX, AZ 85017-4730
(602) 254-7328
(602) 255-0851
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
CSLG6804
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CSLG6804
ARIZONA DEPARTMENT OF HEALTH SERVICES - BUREAU OF MEDICAL FACILITIES LICENSING
AZ
Enumeration date
03/29/2018
Last updated
03/29/2018
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