Provider Demographics
NPI:1194227983
Name:SCOTTSDALE RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:SCOTTSDALE RECOVERY CENTER, LLC
Other - Org Name:ARIZONA ADDICTION RECOVERY CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-699-9044
Mailing Address - Street 1:10446 N 74TH ST STE 150
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-1045
Mailing Address - Country:US
Mailing Address - Phone:602-300-6400
Mailing Address - Fax:
Practice Address - Street 1:16433 N 68TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1500
Practice Address - Country:US
Practice Address - Phone:602-300-6400
Practice Address - Fax:480-284-6749
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SCOTTSDALE RECOVERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-07
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ324500000X
3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility