Basic Information
| Provider Information | |||||||||
| NPI: | 1700257664 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RECOVERY INNOVATIONS, INC | ||||||||
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| OtherOrganizationName: | RI INTERNATIONAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 N 16TH STREET | ||||||||
| Address2: | SUITE 316 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026501212 | ||||||||
| FaxNumber: | 6026365283 | ||||||||
| Practice Location | |||||||||
| Address1: | 309 CRUTCHFIELD STREET | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195607305 | ||||||||
| FaxNumber: | 9195607480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2015 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | OGAZ | ||||||||
| AuthorizedOfficialFirstName: | CORINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR, CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 6026363085 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084A0401X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 251S00000X | MHL-032-605 | NC | Y | Agencies | Community/Behavioral Health |
No ID Information.