Provider Demographics
NPI:1558122937
Name:SCOTT GROUP 010 LLC
Entity Type:Organization
Organization Name:SCOTT GROUP 010 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:703-864-8197
Mailing Address - Street 1:15411 W WADDELL RD STE 102-128
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-5170
Mailing Address - Country:US
Mailing Address - Phone:480-613-7677
Mailing Address - Fax:
Practice Address - Street 1:6551 S 43RD LN
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-6246
Practice Address - Country:US
Practice Address - Phone:480-613-7677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty