Scottsdale Providence Recovery Center

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

SCOTTSDALE PROVIDENCE RECOVERY CENTER

Doing business as

Scottsdale Providence Residential Center

Practice address

9389 E Via del Sol Dr
Scottsdale, AZ 85255-5072

Phone

(480) 284-7440

Fax

(480) 284-4178

NPI assigned

Nov 4, 2022

Organization subpart

Yes

Parent organization

SCOTTSDALE PROVIDENCE RECOVERY CENTERAs reported in NPPES

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

Authorized official

Name

Daniel Joseph Nichols, LCSWNPI 1871944942

Title

Clinical Director

Phone

(602) 448-4055

Specialties & licenses 6

Addresses

Other identifiers 1

Other names 2

• Scottsdale Providence Residential Center Doing business as
• Scottsdale Providence Residential Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Scottsdale Providence Recovery Center2 organizations share this tax ID, including this one

Part of

Scottsdale Providence Recovery Center

Other organizations with this tax ID 1

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

• Scottsdale Providence Recovery Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Scottsdale, AZ
  • NPI 1740641612
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Scottsdale Providence Recovery Center

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Scottsdale, AZ
  • NPI 1740641612
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daniel Nichols, LCSW

  • Clinical Social Worker
  • Scottsdale, AZ
  • NPI 1871944942
  NPD Authorized official
• Andrew David Parker, LMSW

  • Clinical Social Worker
  • Scottsdale, AZ
  • NPI 1437928769
  NPD

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

{
    "created_epoch": "1667520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670198400000",
    "number": "1821705104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8889 E VIA LINDA",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852585420",
            "telephone_number": "480-284-7440",
            "fax_number": "480-284-4178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9389 E VIA DEL SOL DR",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852555072",
            "telephone_number": "480-284-7440",
            "fax_number": "480-284-4178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCOTTSDALE PROVIDENCE RECOVERY CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SCOTTSDALE PROVIDENCE RECOVERY CENTER",
        "enumeration_date": "2022-11-04",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "602-448-4055",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADHS LICENSE",
            "identifier": "BH8061",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Scottsdale Providence Residential Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Scottsdale Providence Residential",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Scottsdale Providence Residential",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Mental Illness Community Based Residential Treatment Facility in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.