Basic Information
| Provider Information | |||||||||
| NPI: | 1356668941 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RECOVERY INNOVATIONS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FREISE HOPE HOUSE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 N 16TH ST STE 316 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850061266 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026501212 | ||||||||
| FaxNumber: | 6026365211 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 8TH ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933042224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026501212 | ||||||||
| FaxNumber: | 6026365211 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2010 | ||||||||
| LastUpdateDate: | 05/12/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | OGAZ | ||||||||
| AuthorizedOfficialFirstName: | CORINA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR, CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 6026363085 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 323P00000X | Y | Residential Treatment Facilities | Psychiatric Residential Treatment Facility |
No ID Information.