Provider Demographics
NPI:1932274180
Name:COLORADO RIVER BEHAVIORAL HEALTH SYSTEM
Entity Type:Organization
Organization Name:COLORADO RIVER BEHAVIORAL HEALTH SYSTEM
Other - Org Name:TRANSITIONAL LIVING CENTER RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ALBERTA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:602-369-0075
Mailing Address - Street 1:1444 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4604
Mailing Address - Country:US
Mailing Address - Phone:602-369-0075
Mailing Address - Fax:928-782-5701
Practice Address - Street 1:1444 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-4604
Practice Address - Country:US
Practice Address - Phone:928-261-8668
Practice Address - Fax:928-782-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSA08ADHS0202251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ163307Medicaid
AZ384591Medicaid