Provider Demographics
NPI:1487180998
Name:COTTONWOOD DE TUCSON, INC.
Entity Type:Organization
Organization Name:COTTONWOOD DE TUCSON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WELCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-743-0411
Mailing Address - Street 1:4110 W SWEETWATER DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-9348
Mailing Address - Country:US
Mailing Address - Phone:520-743-0411
Mailing Address - Fax:520-743-7991
Practice Address - Street 1:4110 W SWEETWATER DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-9348
Practice Address - Country:US
Practice Address - Phone:520-743-0411
Practice Address - Fax:520-743-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4473324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility