NPIMap

Organization Active NPI

The River Source Treatment Center Casa Grande, LLC

Doing business as The River Source Treatment Center

  • Substance Abuse Rehabilitation Facility
  • Arizona City, AZ
National Provider Identifier
1487367314
Registry record updated Jan 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC
Doing business as
The River Source Treatment Center
Practice address
16286 S. Sunland Gin Rd
Ste B
Arizona City, AZ 85123-8512
Phone
(866) 367-8069
Fax
(520) 413-5944
NPI assigned
Jan 5, 2023
Last updated
Jan 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2023

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

Authorized official

Name
Tina Lee
Title
Finance Director
Phone
(520) 582-4718

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X NU Primary

Addresses

Primary practice location

16286 S. Sunland Gin Rd
Ste B
Arizona City, AZ 85123-8512

Mailing address

PO Box 4293
Arizona City, AZ 85123-2669
Phone (480) 298-7301

Other identifiers 1

IdentifierTypeStateIssuer
544985MedicaidAZ

Other names 1

  • The River Source Treatment Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL theriversource.org

National Provider Directory

National Provider Directory
Tax ID family
The River Source Treatment Center Casa Grande LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1672876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672876800000",
    "number": "1487367314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4293",
            "city": "ARIZONA CITY",
            "state": "AZ",
            "postal_code": "851232669",
            "telephone_number": "480-298-7301",
            "fax_number": "520-413-5944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16286 S. SUNLAND GIN RD",
            "address_2": "STE B",
            "city": "ARIZONA CITY",
            "state": "AZ",
            "postal_code": "851238512",
            "telephone_number": "866-367-8069",
            "fax_number": "520-413-5944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-05",
        "last_updated": "2023-01-05",
        "certification_date": "2022-12-09",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "TINA",
        "authorized_official_title_or_position": "FINANCE DIRECTOR",
        "authorized_official_telephone_number": "520-582-4718"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "544985",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "theriversource.org",
            "affiliation": "N",
            "address_1": "16286 S. Sunland Gin Rd Ste B",
            "city": "Arizona City",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "851238512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The River Source Treatment Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Arizona City, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; 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.