Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Prescott Medical Executive Detox

Organization Substance Abuse Rehabilitation Facility · NPI 1982996989

Prescott Medical Executive Detox is a Substance Abuse Rehabilitation Facility in Prescott, Arizona. Licensed in Arizona. Registered with an NPI since 2011.

Licensed in
AZ
In the registry since
2011

Practice location Address checks out

134 S Granite St
Prescott, AZ 86303-4710
Phone: (928) 227-2300
Fax: (928) 445-1416
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Substance Abuse Rehabilitation Facility (primary) Taxonomy 324500000X · Licence 3273 (AZ)

Record details

NPI number1982996989
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Patrick Gallus — Chief Administrator · (928) 899-0128
NPI enumeratedMay 9, 2011
Last updated in NPPESMay 9, 2011
Mailing address134 S Granite St, Prescott, AZ 86303-4710

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