Provider Demographics
NPI:1477973170
Name:AWAKENING RECOVERY CENTER
Entity Type:Organization
Organization Name:AWAKENING RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:PAYNE
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:LISAC
Authorized Official - Phone:480-209-1977
Mailing Address - Street 1:1204 E BASELINE RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1454
Mailing Address - Country:US
Mailing Address - Phone:480-209-1977
Mailing Address - Fax:
Practice Address - Street 1:1204 E BASELINE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1454
Practice Address - Country:US
Practice Address - Phone:480-209-1977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-10360101YA0400X
AZCSLG7734324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty