Provider Demographics
NPI:1356780753
Name:CORE RECOVERY LLC
Entity type:Organization
Organization Name:CORE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-810-1210
Mailing Address - Street 1:34225 N 27TH DR
Mailing Address - Street 2:BLDG. #5 STE. #146
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-6087
Mailing Address - Country:US
Mailing Address - Phone:602-810-1210
Mailing Address - Fax:
Practice Address - Street 1:34225 N 27TH DR
Practice Address - Street 2:BLDG. #5 STE. #146
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-6087
Practice Address - Country:US
Practice Address - Phone:602-810-1210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 261QR0405X
AZLPC13589101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty