MAIN STREET DIAGNOSTIC LLC NPI 1972639748

NPI Information

  • NPI: 1972639748
  • Provider Name: MAIN STREET DIAGNOSTIC, LLC
  • Classification: Substance Abuse Rehabilitation Facility - 324500000X
  • Entity Type: Organization
  • Doing Business As: MINGUS CENTER - RIO DE ESPERANZA
  • Address: 636 N MAIN ST
    COTTONWOOD, AZ
    ZIP 86326
  • Phone: (928) 639-4440

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NPI Details

MAIN STREET DIAGNOSTIC, LLC is a substance abuse rehabilitation facility in Cottonwood, AZ. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. MAIN STREET DIAGNOSTIC, LLC NPI is 1972639748. The provider is registered as an organization entity type.
The provider Is Doing Business As Mingus Center - Rio De Esperanza.

The provider's business location address is:

636 N MAIN ST
COTTONWOOD, AZ
ZIP 86326-725
Phone: (928) 639-4440
Fax: (928) 639-3924

The provider's authorized official is Maria Carrillo .
The authorized official title is Finance Coordinator and has the following contact phone number (928) 639-4440.

The enumeration date for this NPI number is 2/26/2007 and was last updated on 8/22/2020.

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
1324500000XSubstance Abuse Rehabilitation FacilityPENDINGARIZONAYes

What is NPI?

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This page was last updated on: 3/30/2025

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