Provider Demographics
NPI:1225618341
Name:POWER RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:POWER RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TITUS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-386-6705
Mailing Address - Street 1:5625 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-5247
Mailing Address - Country:US
Mailing Address - Phone:858-386-6705
Mailing Address - Fax:
Practice Address - Street 1:1137 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1747
Practice Address - Country:US
Practice Address - Phone:480-572-8189
Practice Address - Fax:480-546-3376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)