The River Source

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

BH-3428 Issued in AZ

Legal business name

THE RIVER SOURCE

Practice address

108 E 2ND Ave
Mesa, AZ 85210-1410

Phone

(888) 687-7332

Fax

(480) 827-1637

NPI assigned

Aug 9, 2010

Organization subpart

No

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

Authorized official

Name

Phillip Westbrooks

Title

President and Ceo

Phone

(480) 206-3999

Specialties & licenses 1

Addresses

Tax ID family

The River Source2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• The River Source

  • Substance Abuse Rehabilitation Facility
  • Casa Grande, AZ
  • NPI 1497167480
  NPD tax ID

Locations

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

{
    "created_epoch": "1281312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484697600000",
    "number": "1336454867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 E 2ND AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852101410",
            "telephone_number": "888-687-7332",
            "fax_number": "480-827-1637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 E 2ND AVE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852101410",
            "telephone_number": "888-687-7332",
            "fax_number": "480-827-1637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE RIVER SOURCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-09",
        "last_updated": "2017-01-18",
        "status": "A",
        "authorized_official_last_name": "WESTBROOKS",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "480-206-3999"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "BH-3428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.