Provider Demographics
NPI:1417552548
Name:WAYPOINT RECOVERY
Entity Type:Organization
Organization Name:WAYPOINT RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-551-6099
Mailing Address - Street 1:PO BOX 455
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:AZ
Mailing Address - Zip Code:85940-0455
Mailing Address - Country:US
Mailing Address - Phone:928-551-6099
Mailing Address - Fax:
Practice Address - Street 1:36316 US 60
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:AZ
Practice Address - Zip Code:85940
Practice Address - Country:US
Practice Address - Phone:928-551-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-04
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation