Provider Demographics
NPI:1083086631
Name:TREATMENT ASSESSMENT SCREENING CENTER, INC
Entity Type:Organization
Organization Name:TREATMENT ASSESSMENT SCREENING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMMUNITY PROGRAMMING
Authorized Official - Prefix:
Authorized Official - First Name:LATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-254-7328
Mailing Address - Street 1:4016 N BLACK CANYON HWY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85017-4730
Mailing Address - Country:US
Mailing Address - Phone:602-254-7328
Mailing Address - Fax:602-255-0851
Practice Address - Street 1:145 E 1300 S STE 101
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-6118
Practice Address - Country:US
Practice Address - Phone:801-203-3761
Practice Address - Fax:801-396-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT28145261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center