NPIMap

Organization Active NPI

Codac Health, Recovery & Wellness, Inc.

Doing business as CODAC Medication Assisted Addiction Treatment

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Tucson, AZ
National Provider Identifier
1992224455
Registry record updated Oct 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CODAC HEALTH, RECOVERY & WELLNESS, INC.
Doing business as
CODAC Medication Assisted Addiction Treatment
Practice address
380 E Fort Lowell Rd
Tucson, AZ 85705-3985
Phone
(520) 202-1796
Fax
(520) 792-4977
NPI assigned
Sep 15, 2017
Last updated
Oct 5, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2026

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

Authorized official

Name
Justin Horsley
Title
Credentialing Specialist
Phone
(520) 327-4505

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

380 E Fort Lowell Rd
Tucson, AZ 85705-3985

Mailing address

PO Box 29650
Phoenix, AZ 85038-9650
Phone (520) 327-4505

Other identifiers 2

IdentifierTypeStateIssuer
000000MedicaidAZ
331673MedicaidAZ

Other names 1

  • CODAC Medication Assisted Addiction Treatment Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Opioid treatment program
Medicare-enrolled since Jul 8, 2026

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1505433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791158400000",
    "number": "1992224455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29650",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850389650",
            "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": "380 E FORT LOWELL RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857053985",
            "telephone_number": "520-202-1796",
            "fax_number": "520-792-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CODAC HEALTH, RECOVERY & WELLNESS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-15",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A",
        "authorized_official_last_name": "HORSLEY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "520-327-4505"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community 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": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000000",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "331673",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CODAC Medication Assisted Addiction Treatment",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CODAC Medication Assisted Addiction Treatment",
            "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 Oct 5, 2026; 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.