Provider Demographics
NPI:1225806359
Name:I AM RECOVERY, INC
Entity Type:Organization
Organization Name:I AM RECOVERY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGEZE
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:425-344-3949
Mailing Address - Street 1:4322 VAN DYKE AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-6402
Mailing Address - Country:US
Mailing Address - Phone:425-344-3949
Mailing Address - Fax:
Practice Address - Street 1:4322 VAN DYKE AVE APT 13
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-6402
Practice Address - Country:US
Practice Address - Phone:425-344-3949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty