Provider Demographics
NPI:1013792118
Name:PARK PLACE RECOVERY AND WELLNESS CENTER LLC.
Entity Type:Organization
Organization Name:PARK PLACE RECOVERY AND WELLNESS CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHASE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC, MS, NCC
Authorized Official - Phone:623-462-8187
Mailing Address - Street 1:13916 N 135TH DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8428
Mailing Address - Country:US
Mailing Address - Phone:623-462-8187
Mailing Address - Fax:
Practice Address - Street 1:1350 E MCKELLIPS RD STE 2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2739
Practice Address - Country:US
Practice Address - Phone:623-462-8187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health