Provider Demographics
NPI:1609418144
Name:PIVOT LLC
Entity Type:Organization
Organization Name:PIVOT LLC
Other - Org Name:PIVOT RECOVERY RESOURCES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUDAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-551-0220
Mailing Address - Street 1:1620 CENTRAL AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4411
Mailing Address - Country:US
Mailing Address - Phone:585-202-9180
Mailing Address - Fax:
Practice Address - Street 1:1620 CENTRAL AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4411
Practice Address - Country:US
Practice Address - Phone:585-202-9180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty