NPIMap

Organization Active NPI

Codac Health, Recovery & Wellness, Inc.

  • Adult Mental Health Clinic/Center
  • Tucson, AZ
National Provider Identifier
1174862007
Registry record updated Sep 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
CODAC HEALTH, RECOVERY & WELLNESS, INC.
Practice address
630 N Alvernon Way
Ste 161
Tucson, AZ 85711-1843
Phone
(520) 318-9222
Fax
(520) 318-3443
NPI assigned
Feb 13, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2015

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

Authorized official

Name
Mr. Dennis Regnier
Title
Ceo
Phone
(520) 327-4505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary

Addresses

Primary practice location

630 N Alvernon Way
Ste 161
Tucson, AZ 85711-1843

Mailing address

1650 E Fort Lowell Rd
Ste 202
Tucson, AZ 85719-2374
Phone (520) 327-4505

Other identifiers 1

IdentifierTypeStateIssuer
805051MedicaidAZ

Other names 1

  • CODAC at Alvernon Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426001693 AZ Part B Supplier - Clinic/Group Practice 6103813811 Receives reassigned benefits from 48 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tucson, AZ

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1360713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443139200000",
    "number": "1174862007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 E FORT LOWELL RD",
            "address_2": "STE 202",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857192374",
            "telephone_number": "520-327-4505",
            "fax_number": "520-202-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 N ALVERNON WAY",
            "address_2": "STE 161",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857111843",
            "telephone_number": "520-318-9222",
            "fax_number": "520-318-3443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CODAC HEALTH, RECOVERY & WELLNESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-13",
        "last_updated": "2015-09-25",
        "status": "A",
        "authorized_official_last_name": "REGNIER",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "520-327-4505",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "805051",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CODAC at Alvernon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.