Provider Demographics
NPI:1497302913
Name:BEYOND THE BASICS
Entity Type:Organization
Organization Name:BEYOND THE BASICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DUPREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:928-814-2220
Mailing Address - Street 1:1600 W UNIVERSITY AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3154
Mailing Address - Country:US
Mailing Address - Phone:928-814-2220
Mailing Address - Fax:
Practice Address - Street 1:1600 W UNIVERSITY AVE STE 205
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3154
Practice Address - Country:US
Practice Address - Phone:928-814-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility