Provider Demographics
NPI:1073717625
Name:ASSISTED RECOVERY CENTER OF ARIZONA
Entity Type:Organization
Organization Name:ASSISTED RECOVERY CENTER OF ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:R
Authorized Official - Last Name:VACOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-264-7897
Mailing Address - Street 1:1000 E INDIAN SCHOOL RD
Mailing Address - Street 2:#B
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-4810
Mailing Address - Country:US
Mailing Address - Phone:602-264-7897
Mailing Address - Fax:602-264-7403
Practice Address - Street 1:1000 E INDIAN SCHOOL RD
Practice Address - Street 2:#B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-4810
Practice Address - Country:US
Practice Address - Phone:602-264-7897
Practice Address - Fax:602-264-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH 2620251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare