Provider Demographics
NPI:1790916583
Name:ASAP
Entity Type:Organization
Organization Name:ASAP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DRUG/ALCOHOL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ELDON
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:928-669-5243
Mailing Address - Street 1:3560 CHEMEHUEVI BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86406-6326
Mailing Address - Country:US
Mailing Address - Phone:928-846-7874
Mailing Address - Fax:
Practice Address - Street 1:12033 AGENCY RD # 730
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-7718
Practice Address - Country:US
Practice Address - Phone:928-669-5243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002772324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility