Provider Demographics
NPI:1245772482
Name:FOUNTAIN HILLS RECOVERY, LLC
Entity Type:Organization
Organization Name:FOUNTAIN HILLS RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-715-2004
Mailing Address - Street 1:16872 E AVENUE OF THE FOUNTAINS
Mailing Address - Street 2:SUITE 204
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-8312
Mailing Address - Country:US
Mailing Address - Phone:800-715-2004
Mailing Address - Fax:480-476-8901
Practice Address - Street 1:16872 E AVENUE OF THE FOUNTAINS
Practice Address - Street 2:SUITE 204
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-8312
Practice Address - Country:US
Practice Address - Phone:800-715-2004
Practice Address - Fax:480-476-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility