Basic Information
| Provider Information | |||||||||
| NPI: | 1639745185 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ARISTA RECOVERY OPERATOR AT PAOLA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19559 NE 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | NORTH MIAMI BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331793501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056513261 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9401 REEDS RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662072532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133491700 | ||||||||
| FaxNumber: | 9133364644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2021 | ||||||||
| LastUpdateDate: | 05/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | JEGER | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 3056513261 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.