Community Medical Services Arizona-Private, LLC
Clinic/Center, Methadone Clinic in Kingman, AZ. Organization (NPI-2).
NPI number1962069468
StatusActive
Last updated in NPPESAug 21, 2025
Details
- NPI
- 1962069468
- Entity type
- Organization (NPI-2)
- Legal business name
- Community Medical Services Arizona-Private, LLC
- Organization subpart
- No
- Enumeration date
- May 21, 2019
- Certification date
- Aug 21, 2025
- Last updated
- Aug 21, 2025
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM2800X | Clinic/Center, Methadone Clinic | – | – | Yes |
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | – | – | |
| 251S00000X | Community/Behavioral Health | – | – | |
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | – | – | |
| 261QR0405X | Clinic/Center, Rehabilitation, Substance Use Disorder | – | – |
Other names
- Community Medical Services-Kingman (Doing Business As)
Practice location
1115 Stockton Hill RoadSuite 103 & 104
Kingman, AZ 86401-6232
Phone 602-248-8886 · Fax 602-248-8999
Mailing address
8444 N 90th St Ste 100Scottsdale, AZ 85258-4437
Phone 602-248-8886 · Fax 602-248-8999
Authorized official
Nick Stavros
Ceo
6022488886
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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