Provider Demographics
NPI:1437852175
Name:RECOVERY CENTER OF AMERICA LLC
Entity Type:Organization
Organization Name:RECOVERY CENTER OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:ELINGE
Authorized Official - Last Name:MOSIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-352-7441
Mailing Address - Street 1:10290 E ASTER LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-7183
Mailing Address - Country:US
Mailing Address - Phone:480-352-7441
Mailing Address - Fax:
Practice Address - Street 1:5216 E DIATOMITE DR
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-5780
Practice Address - Country:US
Practice Address - Phone:480-352-7441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness