Provider Demographics
NPI:1093278277
Name:SCOTTSDALE RECOVERY II, LLC
Entity Type:Organization
Organization Name:SCOTTSDALE RECOVERY II, LLC
Other - Org Name:SWEETWATER LOCATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-466-7773
Mailing Address - Street 1:PO BOX 5943
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85261-5943
Mailing Address - Country:US
Mailing Address - Phone:480-466-7773
Mailing Address - Fax:480-739-6116
Practice Address - Street 1:13402 N 60TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-3806
Practice Address - Country:US
Practice Address - Phone:602-346-9142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTTSDALE RECOVERY II, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-13
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ102815Medicaid