Organization
PRESCOTT MEDICAL EXECUTIVE DETOX
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK GALLUS D.O. (CHIEF ADMINISTRATOR)
(928) 899-0128
Entity
Organization
Contact information
Practice address
134 S GRANITE ST, PRESCOTT, AZ 86303-4710
(928) 227-2300
(928) 445-1416
Mailing address
134 S GRANITE ST, PRESCOTT, AZ 86303-4710
(928) 227-2300
(928) 445-1416
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
3273
AZ
Other
Enumeration date
05/09/2011
Last updated
05/09/2011
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