Organization
SCOTTSDALE PROVIDENCE RECOVERY CENTER
Active
Organization
SCOTTSDALE PROVIDENCE RECOVERY CENTER
Active
Parent organization
SCOTTSDALE PROVIDENCE RECOVERY CENTER
Other names
Scottsdale Providence Residential Center, Scottsdale Providence Residential
Organization subpart
Yes
Provider details
NPI number
Legal business name
SCOTTSDALE PROVIDENCE RECOVERY CENTER
Authorized official
DANIEL JOSEPH NICHOLS LCSW (CLINICAL DIRECTOR)
(602) 448-4055
Entity
Organization
Contact information
Practice address
9389 E VIA DEL SOL DR, SCOTTSDALE, AZ 85255-5072
(480) 284-7440
(480) 284-4178
Mailing address
8889 E VIA LINDA, SCOTTSDALE, AZ 85258-5420
(480) 284-7440
(480) 284-4178
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BH8061
ADHS LICENSE
AZ
Enumeration date
11/04/2022
Last updated
12/05/2022
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