Provider Demographics
NPI:1861817447
Name:CARLETON RECOVERY CENTERS
Entity Type:Organization
Organization Name:CARLETON RECOVERY CENTERS
Other - Org Name:CARLETON RECOVERY CENTERS PRESCOTT MEN'S RESIDENTIAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHAFFNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-778-4600
Mailing Address - Street 1:505 WHIPPLE ST
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-1747
Mailing Address - Country:US
Mailing Address - Phone:928-778-4600
Mailing Address - Fax:928-778-2221
Practice Address - Street 1:1118 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301
Practice Address - Country:US
Practice Address - Phone:928-778-4600
Practice Address - Fax:928-778-2221
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARLETON RECOVERY CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-19
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH4422324500000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility