Granite Mountain Behavioral Health Care of Az, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

GRANITE MOUNTAIN BEHAVIORAL HEALTH CARE OF AZ, LLC

Practice address

8183 E Florentine Rd
Prescott Valley, AZ 86314-8481

Phone

(602) 565-2055

Fax

(602) 565-2055

NPI assigned

Dec 18, 2017

Organization subpart

No

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

Authorized official

Name

Nick Herb

Title

Accountant

Phone

(602) 565-2055

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1513555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513555200000",
    "number": "1992211619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2651 N INDUSTRIAL WAY STE B",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863143545",
            "telephone_number": "602-565-2055",
            "fax_number": "866-758-1208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8183 E FLORENTINE RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863148481",
            "telephone_number": "602-565-2055",
            "fax_number": "602-565-2055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANITE MOUNTAIN BEHAVIORAL HEALTH CARE OF AZ, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-18",
        "last_updated": "2017-12-18",
        "status": "A",
        "authorized_official_last_name": "HERB",
        "authorized_official_first_name": "NICK",
        "authorized_official_title_or_position": "ACCOUNTANT",
        "authorized_official_telephone_number": "602-565-2055"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey John Goesling, PT
• Angela Marie Gonzalez, FNP-BC
• Kiersten Gonzalez
• Robert Whitney Goodell III, LPC
• Angie J Graham, PSY.D.
• Granite Orthopaedics, PLLC
• Granville Assisted Living - Paradise Retreat LLC
• Michael C Grato
• Lisa Mae Diane Graveline, PMHNP-BC, APRN-RNP
• Loleita Leanora Green-Reid, APRN-FNP

• Substance Abuse Rehabilitation Facility in Prescott Valley, AZ
• Providers in Prescott Valley, 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 Dec 18, 2017; 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.