The River Source Outpatient Peoria

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

License

CSLG7631 Issued in AZ

Legal business name

THE RIVER SOURCE OUTPATIENT PEORIA

Practice address

2432 W Peoria Ave
Suite 1227
Phoenix, AZ 85029-4726

Phone

(623) 277-8385

NPI assigned

Apr 4, 2016

Last updated

Apr 4, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John Richards

Title

Director of Account Management

Phone

(561) 413-9860

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1459728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459728000000",
    "number": "1295198497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2432 W PEORIA AVE",
            "address_2": "SUITE 1227",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294737",
            "telephone_number": "623-277-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2432 W PEORIA AVE",
            "address_2": "SUITE 1227",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294726",
            "telephone_number": "623-277-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE RIVER SOURCE OUTPATIENT PEORIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-04",
        "last_updated": "2016-04-04",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "DIRECTOR OF ACCOUNT MANAGEMENT",
        "authorized_official_telephone_number": "561-413-9860"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "AZ",
            "license": "CSLG7631",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• The Resolution Group, Inc.
• The Resolution Group, Inc.
• The River Source Treatment Center Casa Grande, LLC
• The Rosemary Tree, LLC
• The Sacred Wild, LLC (Sacred Wild Midwifery)
• The Safe and Secure Community Health Center LLC
• The Smyl Co

• Substance Use Disorder Rehabilitation Clinic/Center in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; 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.