Basic Information
| Provider Information | |||||||||
| NPI: | 1770718546 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RECOVERY INNOVATIONS OF ARIZONA, INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTHERN ARIZONA | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 N 16TH ST | ||||||||
| Address2: | SUITE 316 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850061263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026501212 | ||||||||
| FaxNumber: | 6026365211 | ||||||||
| Practice Location | |||||||||
| Address1: | 365 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CAMP VERDE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863227272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9285673834 | ||||||||
| FaxNumber: | 9285678711 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2009 | ||||||||
| LastUpdateDate: | 05/22/2009 | ||||||||
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| AuthorizedOfficialLastName: | DYE | ||||||||
| AuthorizedOfficialFirstName: | CHRISTY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6026501212 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | RECOVERY INNOVATIONS OF ARIZONA, INC | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | BH-3261 | AZ | Y | Agencies | Community/Behavioral Health |
No ID Information.