Provider Demographics
NPI:1164799987
Name:NAZCARE, INC POWER RECOVERY CENTER
Entity Type:Organization
Organization Name:NAZCARE, INC POWER RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCS, BHT
Authorized Official - Phone:928-442-9205
Mailing Address - Street 1:599 WHITE SPAR RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-4627
Mailing Address - Country:US
Mailing Address - Phone:928-442-9205
Mailing Address - Fax:928-442-3144
Practice Address - Street 1:367 N MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGAR
Practice Address - State:AZ
Practice Address - Zip Code:85925-9675
Practice Address - Country:US
Practice Address - Phone:928-333-4990
Practice Address - Fax:928-649-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCSA03NA0148302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization