Provider Demographics
NPI:1477226843
Name:EAST VALLEY TREATMENT CENTER LLC
Entity Type:Organization
Organization Name:EAST VALLEY TREATMENT CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ADELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-888-6779
Mailing Address - Street 1:912 N JOHN WAY
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-9026
Mailing Address - Country:US
Mailing Address - Phone:480-636-9363
Mailing Address - Fax:312-610-5767
Practice Address - Street 1:912 N JOHN WAY
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-9026
Practice Address - Country:US
Practice Address - Phone:480-636-9363
Practice Address - Fax:312-610-5767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children