Provider Demographics
NPI:1558988246
Name:CMJ RECOVERY AZ LLC
Entity type:Organization
Organization Name:CMJ RECOVERY AZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-345-5541
Mailing Address - Street 1:1590 S CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5957
Mailing Address - Country:US
Mailing Address - Phone:847-345-5541
Mailing Address - Fax:
Practice Address - Street 1:4122 N 17TH ST BLDG A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5922
Practice Address - Country:US
Practice Address - Phone:818-304-8071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-29
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility