Provider Demographics
NPI:1316129216
Name:NEWLANDS OUTPATIENT TREATMENT CENTER
Entity type:Organization
Organization Name:NEWLANDS OUTPATIENT TREATMENT CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLATCHFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:928-688-3475
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:SANDERS
Mailing Address - State:AZ
Mailing Address - Zip Code:86512-1086
Mailing Address - Country:US
Mailing Address - Phone:928-688-3475
Mailing Address - Fax:928-688-3478
Practice Address - Street 1:1/4 MILES SOUTH OF SANDERS HIGH SCHOOL, SHONDIIN STREET
Practice Address - Street 2:
Practice Address - City:SANDERS
Practice Address - State:AZ
Practice Address - Zip Code:86512-1086
Practice Address - Country:US
Practice Address - Phone:928-688-3475
Practice Address - Fax:928-688-3478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty