Provider Demographics
NPI:1285968024
Name:ABC THERAPY
Entity type:Organization
Organization Name:ABC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAREE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:928-763-4796
Mailing Address - Street 1:3003 HIWAY 95 STE N-104
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7860
Mailing Address - Country:US
Mailing Address - Phone:928-763-0250
Mailing Address - Fax:928-763-0271
Practice Address - Street 1:3003 HIWAY 95 STE N-104
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-7860
Practice Address - Country:US
Practice Address - Phone:928-763-0250
Practice Address - Fax:928-763-0271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16973245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children