NPIMap

Organization Active NPI

Community Medical Services Arizona-Private, LLC

  • Methadone Clinic
  • Kingman, AZ
National Provider Identifier
1962069468
Registry record updated Aug 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
COMMUNITY MEDICAL SERVICES ARIZONA-PRIVATE, LLC
Practice address
1115 Stockton Hill Road
Suite 103 & 104
Kingman, AZ 86401-6232
Phone
(602) 248-8886
Fax
(602) 248-8999
NPI assigned
May 21, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2025

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

Authorized official

Name
Nick Stavros
Title
Ceo
Phone
(602) 248-8886

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Community/Behavioral Health Agency 251S00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Methadone Clinic 261QM2800X Primary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X

Addresses

Primary practice location

1115 Stockton Hill Road
Suite 103 & 104
Kingman, AZ 86401-6232

Mailing address

8444 N 90TH St Ste 100
Scottsdale, AZ 85258-4437
Phone (602) 248-8886

Other names 1

  • Community Medical Services-Kingman Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200416000394 AZ Part B Supplier - Opioid Treatment Program (Otp) 1759711625 26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tucson, AZ; Yuma, AZ; Tempe, AZ; Sierra Vista, AZ; Show Low, AZ; Safford, AZ; Prescott Valley, AZ; Phoenix, AZ…

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory

Locations

1115 N Stockton Hill Rd
Ste 103
Kingman, AZ 86401
Phone (928) 565-6599

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1558396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755734400000",
    "number": "1962069468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8444 N 90TH ST STE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584437",
            "telephone_number": "602-248-8886",
            "fax_number": "602-248-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 STOCKTON HILL ROAD",
            "address_2": "SUITE 103 & 104",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864016232",
            "telephone_number": "602-248-8886",
            "fax_number": "602-248-8999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEDICAL SERVICES ARIZONA-PRIVATE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-21",
        "last_updated": "2025-08-21",
        "certification_date": "2025-08-21",
        "status": "A",
        "authorized_official_last_name": "STAVROS",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-248-8886"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Medical Services-Kingman",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Community Medical Services-Kingman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kingman, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2025; 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.