Provider Demographics
NPI:1487687182
Name:CODAC HEALTH, RECOVERY & WELLNESS, INC.
Entity Type:Organization
Organization Name:CODAC HEALTH, RECOVERY & WELLNESS, INC.
Other - Org Name:CODAC FIRST/METHADONE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:REGNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-327-4505
Mailing Address - Street 1:1650 E FORT LOWELL RD
Mailing Address - Street 2:STE 202
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2378
Mailing Address - Country:US
Mailing Address - Phone:520-327-4505
Mailing Address - Fax:520-202-1889
Practice Address - Street 1:3100 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2513
Practice Address - Country:US
Practice Address - Phone:520-202-1960
Practice Address - Fax:520-622-5358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC5996OtherARIZONA LICENSE
AZ354217Medicaid
AZZ71967Medicare PIN