NPIMap

Organization Active NPI

The River Source Treatment Center Casa Grande, LLC

  • Addiction (Substance Use Disorder) Psychologist
  • Arizona City, AZ
National Provider Identifier
1568243103
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X
Legal business name
THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC
Practice address
16286 S. Sunland Gin Rd
Arizona City, AZ 85123-8512
Phone
(480) 298-7301
NPI assigned
Oct 10, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 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
Addiction (Substance Use Disorder) PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TA0400X Primary

Addresses

Primary practice location

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

Mailing address

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

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": "1696896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1568243103",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16286 S. SUNLAND GIN RD",
            "city": "ARIZONA CITY",
            "state": "AZ",
            "postal_code": "851238512",
            "telephone_number": "480-298-7301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE RIVER SOURCE TREATMENT CENTER CASA GRANDE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-10",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-06",
        "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": "103TA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Oct 10, 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.