The River Source Iop LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

THE RIVER SOURCE IOP LLC

Practice address

128 W Pepper PL
Mesa, AZ 85201-7317

Phone

(480) 735-8346

NPI assigned

Nov 13, 2013

Organization subpart

No

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

Authorized official

Name

Matthew Luchini

Title

Insurance Administrator

Phone

(928) 533-4220

Specialties & licenses 1

Addresses

Tax ID family

The River Source Iop2 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 Iop

  • Substance Abuse Rehabilitation Facility
  • Mesa, AZ
  • NPI 1700262490
  NPD tax ID

Locations

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

{
    "created_epoch": "1384300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396224000000",
    "number": "1538599469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 W PEPPER PL",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852017317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 W PEPPER PL",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852017317",
            "telephone_number": "480-735-8346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE RIVER SOURCE IOP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-13",
        "last_updated": "2014-03-31",
        "status": "A",
        "authorized_official_last_name": "LUCHINI",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "INSURANCE ADMINISTRATOR",
        "authorized_official_telephone_number": "928-533-4220"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Resolution Group, Inc.
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• The River Source
• The River Source Iop
• The Sleep and Wellness Doc LLC
• The Source Naturopathic Medical Clinic
• The Spine Docs, LLC (North Mesa Chiropractic)
• The Stone Community Health Center, LLC
• The Therapy Garden LLC

• 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 Mar 31, 2014; 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.