CCR OTC LLC NPI 1700281219

NPI Information

NPI: 1700281219
Provider Name: CCR OTC LLC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 03D2072275

Address:
819 W GURLEY ST UNIT C
PRESCOTT, AZ
ZIP 86305
Phone: (928) 671-0161
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CCR OTC LLC is a rehabilitation and substance use disorder clinic center in Prescott, AZ. CCR OTC LLC NPI is 1700281219. The provider is registered as an organization entity type.

The provider's business location address is:

819 W GURLEY ST UNIT C
PRESCOTT, AZ
ZIP 86305-626
Phone: (928) 671-0161
Fax: (928) 708-9620

The provider's authorized official is Erin Bachman .
The authorized official title is Cfo and has the following contact phone number (928) 671-0161.

The CLIA number assigned to this NPI record is 03D2072275 - other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/27/2014 and was last updated on 10/27/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	10486	ARIZONA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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