Provider Demographics
NPI:1770955338
Name:NORTHERN ARIZONA CENTER FOR ADDICTION, LLC
Entity type:Organization
Organization Name:NORTHERN ARIZONA CENTER FOR ADDICTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-642-3030
Mailing Address - Street 1:3195 STILLWATER DR STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-7171
Mailing Address - Country:US
Mailing Address - Phone:928-642-3030
Mailing Address - Fax:928-778-1089
Practice Address - Street 1:195 PLAZA DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-5549
Practice Address - Country:US
Practice Address - Phone:928-499-5687
Practice Address - Fax:928-778-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-22
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC 7348261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder