Provider Demographics
NPI:1821562919
Name:LANDMARK RECOVERY OUTPATIENT SERVICES, LLC
Entity Type:Organization
Organization Name:LANDMARK RECOVERY OUTPATIENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCHUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-619-8556
Mailing Address - Street 1:4835 E CACTUS RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3545
Mailing Address - Country:US
Mailing Address - Phone:888-448-0302
Mailing Address - Fax:
Practice Address - Street 1:4825 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-1800
Practice Address - Country:US
Practice Address - Phone:888-448-0302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health