Provider Demographics
NPI:1083095467
Name:GALLUS DETOX SCOTTSDALE
Entity Type:Organization
Organization Name:GALLUS DETOX SCOTTSDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR & DIRECTOR OF NURSING
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:928-227-2300
Mailing Address - Street 1:4326 N 75TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-3505
Mailing Address - Country:US
Mailing Address - Phone:928-227-2300
Mailing Address - Fax:928-771-0206
Practice Address - Street 1:4326 N 75TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3505
Practice Address - Country:US
Practice Address - Phone:928-227-2300
Practice Address - Fax:928-771-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility