Organization
MAIN STREET DIAGNOSTIC, LLC
Active
Other names
MINGUS CENTER - RIO DE ESPERANZA
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA CARRILLO (FINANCE COORDINATOR)
(928) 639-4440
Entity
Organization
Contact information
Practice address
636 N MAIN ST, COTTONWOOD, AZ 86326-3725
(928) 639-4440
(928) 639-3924
Mailing address
636 N MAIN ST, COTTONWOOD, AZ 86326-3725
(928) 639-4440
(928) 639-3924
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
PENDING
AZ
Other
Enumeration date
02/26/2007
Last updated
08/22/2020
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