Provider Demographics
NPI:1073386355
Name:CORE RECOVERY LLC
Entity Type:Organization
Organization Name:CORE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-698-3757
Mailing Address - Street 1:16515 S 40TH ST STE 119B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85048-0559
Mailing Address - Country:US
Mailing Address - Phone:602-810-1210
Mailing Address - Fax:480-247-5625
Practice Address - Street 1:16515 S 40TH ST STE 119B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85048-0559
Practice Address - Country:US
Practice Address - Phone:602-810-1210
Practice Address - Fax:480-247-5625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder