Basic Information
Provider Information
NPI: 1609009919
EntityType: 2
ReplacementNPI:  
OrganizationName: RECOVERY INNOVATIONS, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2701 N 16TH ST STE 316
Address2:  
City: PHOENIX
State: AZ
PostalCode: 850061266
CountryCode: US
TelephoneNumber: 6026501212
FaxNumber: 6026501616
Practice Location
Address1: 2245 STANTONSBURG ROAD
Address2: SUITES O & P
City: GREENVILLE
State: NC
PostalCode: 27834
CountryCode: US
TelephoneNumber: 2523210179
FaxNumber: 2523210578
Other Information
ProviderEnumerationDate: 09/02/2009
LastUpdateDate: 06/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: OGAZ
AuthorizedOfficialFirstName: CORINA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: ASSOCIATE DIRECTOR, CREDENTIALING
AuthorizedOfficialTelephone: 6026363085
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/21/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

No ID Information.


Home