NPIMap

Organization Active NPI

Codac Health, Recovery & Wellness, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tucson, AZ
National Provider Identifier
1235569328
Registry record updated Sep 25, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
License
CSLG7120 Issued in AZ
Legal business name
CODAC HEALTH, RECOVERY & WELLNESS, INC.
Practice address
2001 W Orange Grove Rd
Ste 416
Tucson, AZ 85704-1139
Phone
(520) 327-4505
Fax
(520) 202-1889
NPI assigned
Nov 26, 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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X CSLG7120 AZ Primary
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X

Addresses

Primary practice location

2001 W Orange Grove Rd
Ste 416
Tucson, AZ 85704-1139

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
025747MedicaidAZ

Other names 1

  • CODAC at Desert Life 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

Locations

2001 W Orange Grove Rd
Ste 416
Tucson, AZ 85704
Phone (520) 888-3032

NPI Registry JSON

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

{
    "created_epoch": "1385424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443139200000",
    "number": "1235569328",
    "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": "2001 W ORANGE GROVE RD",
            "address_2": "STE 416",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857041139",
            "telephone_number": "520-327-4505",
            "fax_number": "520-202-1889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CODAC HEALTH, RECOVERY & WELLNESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-26",
        "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": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AZ",
            "license": "CSLG7120",
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "025747",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CODAC at Desert Life",
            "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.