Provider Demographics
NPI:1679800106
Name:WESTCARE ARIZONA I, INC.
Entity Type:Organization
Organization Name:WESTCARE ARIZONA I, INC.
Other - Org Name:SAGE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:928-763-1945
Mailing Address - Street 1:821 HANCOCK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5034
Mailing Address - Country:US
Mailing Address - Phone:928-763-1945
Mailing Address - Fax:928-763-5157
Practice Address - Street 1:1800 RIO VISTA DR
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7229
Practice Address - Country:US
Practice Address - Phone:928-758-0603
Practice Address - Fax:928-758-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH-34233245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children