Provider Demographics
NPI:1356182539
Name:RECOVERY CENTER ARIZONA
Entity type:Organization
Organization Name:RECOVERY CENTER ARIZONA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUKIASYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-603-0000
Mailing Address - Street 1:1620 N 48TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7723
Mailing Address - Country:US
Mailing Address - Phone:602-603-0000
Mailing Address - Fax:602-275-1256
Practice Address - Street 1:1620 N 48TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7723
Practice Address - Country:US
Practice Address - Phone:602-603-0000
Practice Address - Fax:602-275-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility