Provider Demographics
NPI:1346708179
Name:EXHALE RECOVERY LLC
Entity Type:Organization
Organization Name:EXHALE RECOVERY LLC
Other - Org Name:EXHALE PTSD RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-809-6551
Mailing Address - Street 1:2955 E MAHOGANY PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-3596
Mailing Address - Country:US
Mailing Address - Phone:480-809-6551
Mailing Address - Fax:
Practice Address - Street 1:2955 E MAHOGANY PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-3596
Practice Address - Country:US
Practice Address - Phone:480-809-6551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467897330OtherPHYSICIAN
1841444023OtherNPI TYPE-1