CCR Intergrated Health

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

CCR INTERGRATED HEALTH

Practice address

12268 W Delwood Drive
3699
Arizona City, AZ 85123

Phone

(228) 383-1240

NPI assigned

Mar 30, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Clarence Vanard Burton

Title

Director of Operations

Phone

(228) 383-1240

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• N/A Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1427673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427673600000",
    "number": "1073908810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 3699",
            "city": "ARIZONA CITY",
            "state": "AZ",
            "postal_code": "85123",
            "telephone_number": "228-383-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12268 W DELWOOD DRIVE",
            "address_2": "3699",
            "city": "ARIZONA CITY",
            "state": "AZ",
            "postal_code": "85123",
            "telephone_number": "228-383-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCR INTERGRATED HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-30",
        "last_updated": "2015-03-30",
        "status": "A",
        "authorized_official_last_name": "BURTON",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "VANARD",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "228-383-1240",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": null,
            "primary": true
        },
        {
            "code": "323P00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Residential Treatment Facility",
            "state": "AZ",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "503218",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "N/A",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Amori Marche'T Barth
• Jennifer Kathleen Beatty-Kwan, MD PHD
• Bradley Paul Burke, D.C.
• Burton Healthcare Services
• George Carroll
• Rekha Cheriyan, FNP-C
• Desert Rose Healt Care Services
• Desert Senita Community Health Center
• Desert Senita Community Health Center
• Desert Senita Community Health Center

• All providers in Arizona City, AZ
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.