Organization
THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA VALENCIA (FINANCE DIRECTOR)
(480) 298-7301
Entity
Organization
Contact information
Practice address
2325 W GUADALUPE RD BLDG 2 STE 107, GILBERT, AZ 85233-2811
(866) 367-8069
(520) 413-5944
Mailing address
PO BOX 4293, ARIZONA CITY, AZ 85123-2669
(480) 298-7301
(520) 413-5944
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
544985
—
AZ
Enumeration date
01/02/2023
Last updated
10/07/2024
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