Provider Demographics
NPI:1710420286
Name:ACADIA HEALTHCARE INC
Entity type:Organization
Organization Name:ACADIA HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:928-530-4546
Mailing Address - Street 1:410 RIATA VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-2976
Mailing Address - Country:US
Mailing Address - Phone:928-530-4546
Mailing Address - Fax:
Practice Address - Street 1:2699 E ANDY DEVINE
Practice Address - Street 2:SUITE B
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401
Practice Address - Country:UM
Practice Address - Phone:928-753-7107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP7850363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty