Provider Demographics
NPI:1649762238
Name:CR RESORTS, LLC
Entity Type:Organization
Organization Name:CR RESORTS, LLC
Other - Org Name:CANYON RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DITTMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-749-9655
Mailing Address - Street 1:8600 E ROCKCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-9733
Mailing Address - Country:US
Mailing Address - Phone:520-749-9655
Mailing Address - Fax:520-749-0662
Practice Address - Street 1:8600 E ROCKCLIFF RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-9733
Practice Address - Country:US
Practice Address - Phone:520-749-9655
Practice Address - Fax:520-749-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC8497261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZOTC8497OtherARIZONA OUTPATIENT TREATMENT CENTER LICENSE