CCR OTC LLC NPI 1700281219

NPI Information

  • NPI: 1700281219
  • Provider Name: CCR OTC LLC
  • Classification: Clinic/Center - 261QR0405X
  • Specialization: Rehabilitation, Substance Use Disorder
  • Entity Type: Organization
  • CLIA Number: 03D2072275
  • Address: 819 W GURLEY ST UNIT C
    PRESCOTT, AZ
    ZIP 86305
  • Phone: (928) 671-0161

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NPI Details

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 - co-iop 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
1261QR0405XClinic/CenterRehabilitation, Substance Use Disorder10486ARIZONAYes

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: 3/30/2025

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