Verify Your Insurance

This is not an application for admission, and is for your information only. All information you submit will be kept confidential.

Patient information.

Patient's full name*

First*

Last*

Patient's date of birth*

Contact information.

Your phone number*Your email address*

Insurance information.

Insurance

Private pay

Insurance basics

Insurance Provider Name

Insurance Member ID Number

For a quicker verification, fill out a few additional fields

Fill out as many of the fields below as you are able to help cut down turnaround time.

Additional insurance information.

Insurance details continued

Insurance Group Number

Insurance Type

Insurance Company Phone #

Additional patient information.

Patient's last four ssnPatient's addressStreet AddressAddress Line 2 - Unit, Apartment Number

City

State

Zip Code

Primary insured information.

Provide the following information if the person entering treatment is not the primary policy holder.

Primary insured's full name

First

Last

Primary insured's date of birthPrimary insured's last four ssnPrimary insured's phone numberPrimary insured's email address

Our treatment philosphy.

At Northern Arizona Center for Addiction, we believe that healing of the body, mind and spirit are all necessary to overcome substance abuse. We offer a wide range of rehab options in order to facilitate your personal recovery. Our clients can go through drug and alcohol rehabilitation in a safe, comfortable environment, with holistic plans customized to their needs.

Substance Abuse.

Co-Occurring Disorders.

Family Resources.

Verify your insurance

Verifying your insurance is a quick way to simplify the admissions process at Northern Arizona Center for Recovery.