Provider Demographics
NPI:1417709551
Name:PARTNERS IN RECOVERY, LLC
Entity Type:Organization
Organization Name:PARTNERS IN RECOVERY, LLC
Other - Org Name:PARTNERS IN RECOVERY, LLC ACT2 METRO IHH
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF RISK AND COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LATRICE
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:HICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-431-9008
Mailing Address - Street 1:924 N COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-4108
Mailing Address - Country:US
Mailing Address - Phone:480-969-3800
Mailing Address - Fax:
Practice Address - Street 1:10240 NORTH 31ST AVENUE
Practice Address - Street 2:SUITES 101, 105, 109, 120, 200, 201, 210, 218, 220
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051
Practice Address - Country:US
Practice Address - Phone:602-997-9006
Practice Address - Fax:602-997-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH3663OtherARIZONA DEPARTMENT OF HEALTH SERVICES - LICENSING