Provider Demographics
NPI:1477104362
Name:MODERN RECOVERY, LLC
Entity Type:Organization
Organization Name:MODERN RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-200-8556
Mailing Address - Street 1:11445 E VIA LINDA STE 2-617
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2655
Mailing Address - Country:US
Mailing Address - Phone:203-200-8556
Mailing Address - Fax:
Practice Address - Street 1:4535 S LAKESHORE DR STE 1B
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7046
Practice Address - Country:US
Practice Address - Phone:203-200-8556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder