Provider Demographics
NPI:1972170322
Name:CARELOCK, LLC
Entity type:Organization
Organization Name:CARELOCK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-681-3450
Mailing Address - Street 1:15029 N THOMPSON PEAK PKWY
Mailing Address - Street 2:STE B-111 # 438
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-681-3450
Mailing Address - Fax:
Practice Address - Street 1:20172 E STAGECOACH TRL STE B
Practice Address - Street 2:
Practice Address - City:MAYER
Practice Address - State:AZ
Practice Address - Zip Code:86333-2357
Practice Address - Country:US
Practice Address - Phone:928-632-4399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARELOCK LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-04
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty