CODAC HEALTH, RECOVERY & WELLNESS, INC. (NPI# 1376931493) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376931493 |
| Entity Type | Organization |
| Organization Name | CODAC HEALTH, RECOVERY & WELLNESS, INC. |
| Other Organization Name | CODAC COBBLESTONE COURT |
| Practice Address |
1075 E Fort Lowell Rd Tucson AZ 85719-2159 |
| Mailing Address |
1650 E Fort Lowell Rd Ste 202 Tucson AZ 85719-2374 |
| Practice Telephone | 5203274505 |
| Practice Fax Number | 5202021889 |
| Mailing Telephone | 5203274505 |
| Mailing Fax Number | 5202021889 |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2015-09-25 |
| Authorized Official Name | MR. DENNIS REGNIER (CEO) |
| Authorized Official Telephone | 5203274505 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2300X |
Clinic/Center Specialization: Primary Care |
OTC | AZ | Ambulatory Health Care Facilities |
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
OTC | AZ | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 025936 | 05 |
| Other Name | Type Code |
|---|---|
| CODAC Cobblestone Court | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699226068 | Codac Health, Recovery & Wellness, Inc. | Community Based Residential Treatment Facility, Mental Illness | 2482 N Palo Verde Ave, Tucson, AZ 85716-2548 | 2016-10-20 |
| 1255881355 | Codac Health, Recovery & Wellness, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4801 E Helen St, Tucson, AZ 85712-4717 | 2016-10-12 |
| 1518358530 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 1600 N Country Club Rd, Tucson, AZ 85716-3119 | 2015-02-12 |
| 1750797692 | Codac Health, Recovery & Wellness, Inc. | Community Based Residential Treatment Facility, Mental Illness | 4758 E Andrew St, Tucson, AZ 85711-6427 | 2014-07-10 |
| 1952685414 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 1080 S 10th Ave, Tucson, AZ 85701-2907 | 2011-10-03 |
| 1467475434 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 502 N Silverbell Rd, Tucson, AZ 85745-2626 | 2006-07-25 |
| 1730570102 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 101 W Irvington Rd, Office 3 A, Tucson, AZ 85714-3050 | 2015-02-06 |
| 1801207642 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 3130 E Broadway Blvd, Tucson, AZ 85716-5863 | 2014-05-14 |
| 1235569328 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 2001 W Orange Grove Rd, Ste 416, Tucson, AZ 85704-1139 | 2013-11-26 |
| 1174862007 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 630 N Alvernon Way, Ste 161, Tucson, AZ 85711-1843 | 2013-02-13 |
| Street Address |
1075 E FORT LOWELL RD |
| City | TUCSON |
| State | AZ |
| Zip Code | 85719-2159 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083811665 | Herald Surya | Nurse Practitioner | 1075 E Fort Lowell Rd, Tucson, AZ 85719 | 2007-06-28 |
| 1760021042 | Maria Elena Nickel | Nurse Practitioner | 1075 E Fort Lowell Rd, Tucson, AZ 85719-2159 | 2020-01-03 |
| 1740795582 | Carolyn Marie Guajardo | Counselor | 1075 E Fort Lowell Rd, Tucson, AZ 85719-2159 | 2017-12-01 |
| 1386092690 | Julie Birns | Registered Nurse | 1075 E Fort Lowell Rd, Tucson, AZ 85719-2159 | 2016-05-26 |
| 1275994725 | Jeneane Maureen Keller | Registered Nurse | 1075 E Fort Lowell Rd, Tucson, AZ 85719-2159 | 2016-03-11 |
| 1760883821 | Genoa Healthcare, LLC | Pharmacy | 1075 E Fort Lowell Rd, Tucson, AZ 85719-2159 | 2014-09-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649813635 | Ishani Ravindra Deo | Psychologist | 1051 E Mabel St, Tucson, AZ 85719 | 2019-10-22 |
| 1235793100 | Jacquelyn Christine Wagner | Pediatrics | 1625 N Campbell, Tucson, AZ 85719 | 2019-04-26 |
| 1831652189 | Derek Allan Hatfield | Emergency Medicine | 1625 N Campbell Ave., Tucson, AZ 85719 | 2019-04-12 |
| 1053874305 | Travis Patrick Martin | Emergency Medicine | 1625 N. Campbell Ave, Tucson, AZ 85719 | 2019-04-12 |
| 1245793504 | Martin Cisneroz | Emergency Medicine | 1625 North Campbell Avenue, Tucson, AZ 85719 | 2019-04-12 |
| 1174086722 | Sarah Joy Ring | Emergency Medicine | 1625 N. Campbell Ave., Tucson, AZ 85719 | 2019-04-10 |
| 1790245520 | Akash M Doshi | Student in an Organized Health Care Education/Training Program | 3838 N Campbell Avenue, Bldg 2, Tuscon, AZ 85719 | 2019-03-20 |
| 1942773668 | Jeffery Roy Small | Massage Therapist | 3607 N Vine, Tucson, AZ 85719 | 2019-01-04 |
| 1114434180 | Elizabeth Irene Welch | Behavioral Analyst | 1430 E Fort Lowell Rd Ste 100, Tucson, AZ 85719 | 2017-12-29 |
| 1477076255 | Medavail Pharmacy Inc. | Pharmacy | 1430 E Fort Lowell Rd Ste 120, Tucson, AZ 85719 | 2017-07-24 |
| Find all providers in zip 85719 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013545144 | Tucson Counseling Associates, LLC | Clinic/Center | 125 E Mabel St, Tucson, AZ 85705-6654 | 2020-04-01 |
| 1043844756 | Restored Hope Counseling and Coaching Services | Clinic/Center | 4537 W Lord Redman Loop, Tucson, AZ 85741-4042 | 2020-03-03 |
| 1245876259 | Bamboo Wellness Pllc | Clinic/Center | 5151 E Broadway Blvd Ste 720, Tucson, AZ 85711-3783 | 2019-11-25 |
| 1245777481 | Sonora Behavioral Health Hospital, LLC | Clinic/Center | 2001 West Orange Grove Road, Suite 114, 112, 102, Tucson, AZ 85704 | 2017-01-26 |
| 1174997092 | Banner -- University Medicine Crisis Response Center LLC | Clinic/Center | 2802 E District St Fl 2, Tucson, AZ 85714-2081 | 2015-11-16 |
| 1295129823 | Terros, Inc. | Clinic/Center | 3385 N Campbell Ave, Tucson, AZ 85719-2306 | 2015-03-20 |
| 1518358530 | Codac Health, Recovery & Wellness, Inc. | Clinic/Center | 1600 N Country Club Rd, Tucson, AZ 85716-3119 | 2015-02-12 |
| 1053524348 | Pasadera Behavioral Health Network, Inc. | Clinic/Center | 2502 N. Dodge Blvd., Suite 190, Tucson, AZ 85716-2675 | 2007-05-07 |
| 1356482236 | Maple Star Nevada | Clinic/Center | 100 Washington St. Ste 350, Tucson, AZ 85711 | 2007-02-12 |
| 1659432763 | Adaptive Living Institute | Clinic/Center | 434 E 9th St, Tucson, AZ 85705-8580 | 2006-12-12 |
| Find all providers in TUCSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.