Provider Demographics
NPI:1356050686
Name:PARAMOUNT RECOVERY CENTER LLC
Entity type:Organization
Organization Name:PARAMOUNT RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-903-7445
Mailing Address - Street 1:PO BOX 4333
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86302-4333
Mailing Address - Country:US
Mailing Address - Phone:928-583-4878
Mailing Address - Fax:
Practice Address - Street 1:2211 S MILL AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-2115
Practice Address - Country:US
Practice Address - Phone:928-583-4878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARAMOUNT RECOVERY CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-15
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health