Provider Demographics
NPI:1568817880
Name:ANHARO LLC
Entity type:Organization
Organization Name:ANHARO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BORDELON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-295-1010
Mailing Address - Street 1:1110 E ROUTE 66
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4771
Mailing Address - Country:US
Mailing Address - Phone:425-295-1010
Mailing Address - Fax:
Practice Address - Street 1:1110 E ROUTE 66
Practice Address - Street 2:SUITE 200
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4771
Practice Address - Country:US
Practice Address - Phone:425-295-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-25
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC7650261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder