NPIMap

Organization Active NPI

Codac Health, Recovery & Wellness, Inc.

Doing business as Gila House

  • Mental Illness Community Based Residential Treatment Facility
  • Tucson, AZ
National Provider Identifier
1699226068
Registry record updated Dec 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
CODAC HEALTH, RECOVERY & WELLNESS, INC.
Doing business as
Gila House
Practice address
2482 N Palo Verde Ave
Tucson, AZ 85716-2548
Phone
(520) 327-4505
Fax
(520) 202-1889
NPI assigned
Oct 20, 2016
Last updated
Dec 27, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2016

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

Authorized official

Name
Mr. Dennis Regnier
Title
President & Ceo
Phone
(520) 327-4505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X AZ Primary

Addresses

Primary practice location

2482 N Palo Verde Ave
Tucson, AZ 85716-2548

Mailing address

1650 E Fort Lowell Rd
Ste 202
Tucson, AZ 85719-2374
Phone (520) 327-4505

Other identifiers 1

IdentifierTypeStateIssuer
BH5053OtherAZLICENSE

Other names 1

  • Gila House Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040426001693 AZ Part B Supplier - Clinic/Group Practice 6103813811 Receives reassigned benefits from 48 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tucson, AZ

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Codac Health Recovery13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1476921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482796800000",
    "number": "1699226068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 E FORT LOWELL RD",
            "address_2": "STE 202",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857192374",
            "telephone_number": "520-327-4505",
            "fax_number": "520-202-1889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2482 N PALO VERDE AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857162548",
            "telephone_number": "520-327-4505",
            "fax_number": "520-202-1889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CODAC HEALTH, RECOVERY & WELLNESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-20",
        "last_updated": "2016-12-27",
        "status": "A",
        "authorized_official_last_name": "REGNIER",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "520-327-4505",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "BH5053",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gila House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.