Provider Demographics
NPI:1699363770
Name:DEMBRO RECOVERY SERVICES
Entity Type:Organization
Organization Name:DEMBRO RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LAC NCC
Authorized Official - Phone:520-217-0915
Mailing Address - Street 1:3101 N CENTRAL AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2828
Mailing Address - Country:US
Mailing Address - Phone:520-217-0915
Mailing Address - Fax:
Practice Address - Street 1:136 E DATE AVE
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4921
Practice Address - Country:US
Practice Address - Phone:520-217-0951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness