Provider Demographics
NPI:1306398581
Name:ARIZONA RECOVERY CARE CENTER LLC
Entity Type:Organization
Organization Name:ARIZONA RECOVERY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:YEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-216-6908
Mailing Address - Street 1:1635 E MYRTLE AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-5556
Mailing Address - Country:US
Mailing Address - Phone:602-216-6908
Mailing Address - Fax:
Practice Address - Street 1:1635 E MYRTLE AVE
Practice Address - Street 2:STE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-5556
Practice Address - Country:US
Practice Address - Phone:602-216-6908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-03
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRCC-16-1318261QR0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care