Provider Demographics
NPI:1376072884
Name:RECOVIA
Entity Type:Organization
Organization Name:RECOVIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARB
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-697-3488
Mailing Address - Street 1:8322 E HARTFORD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6568
Mailing Address - Country:US
Mailing Address - Phone:480-712-4600
Mailing Address - Fax:602-428-7045
Practice Address - Street 1:8322 E HARTFORD DR STE 100
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6568
Practice Address - Country:US
Practice Address - Phone:480-712-4600
Practice Address - Fax:602-428-7045
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOTC8039251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ115701Medicaid