Provider Demographics
NPI:1629651971
Name:UNITED RECOVERY CENTERS
Entity Type:Organization
Organization Name:UNITED RECOVERY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARFARAZ
Authorized Official - Middle Name:ABDEALI
Authorized Official - Last Name:JASDANWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-953-5636
Mailing Address - Street 1:17781 HORNBEAN DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-4229
Mailing Address - Country:US
Mailing Address - Phone:760-908-1253
Mailing Address - Fax:
Practice Address - Street 1:17781 HORNBEAN DR
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63005-4229
Practice Address - Country:US
Practice Address - Phone:760-908-1253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Single Specialty