Provider Demographics
NPI:1184193963
Name:EMBARK RECOVERY LLC
Entity Type:Organization
Organization Name:EMBARK RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-215-2224
Mailing Address - Street 1:3727 KARICIO LN
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6829
Mailing Address - Country:US
Mailing Address - Phone:877-215-2224
Mailing Address - Fax:877-215-2224
Practice Address - Street 1:3727 KARICIO LN
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-6829
Practice Address - Country:US
Practice Address - Phone:877-215-2224
Practice Address - Fax:877-215-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ520332Medicaid