PRESCOTT MEDICAL EXECUTIVE DETOX
Residential Treatment Facilities at Granite St, Prescott, AZ

License number
Arizona 3273
Category
Residential Treatment Facilities
Type
Substance Abuse Rehabilitation Facility
Owner
Name: PATRICK GALLUS D.O.
Title: CHIEF ADMINISTRATOR
Phone: (928) 899-0128
Address
Address
134 S Granite St, Prescott, AZ 86303
National Provider ID: 1982996989
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

See more information about PRESCOTT MEDICAL EXECUTIVE DETOX at bizstanding.com

PRESCOTT MEDICAL EXECUTIVE DETOX, LLC

134 S Granite St, Prescott, AZ 86303

Industry:
Refuse System
Registration:
Feb 17, 2011
State ID:
L-1660771-0
Expiration:
PERPETUAL
Manager, Chief Administrator, Member, Osteopathys:
Gina Carroll (Administration),Patrick Gallus Manager, Chief Administrator, Member, Osteopathy, inactive, 8645 N Granite Oaks Dr, Prescott, AZ 86305 (Physical)

Residential Treatment Facilities licenses in Arizona









Other Doctors licenses in Arizona