Organization
BLUE VASE RECOVERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROCK BEVELL (CEO)
(480) 216-5420
Entity
Organization
Contact information
Practice address
1201 E COOLEY ST, SUITE B, SHOW LOW, AZ 85901-5122
(480) 216-5420
Mailing address
1201 E COOLEY ST, SUITE B, SHOW LOW, AZ 85901-5122
(480) 216-5420
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
OTC7145
AZ
Other
Enumeration date
05/15/2015
Last updated
01/11/2017
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