Provider Demographics
NPI:1669289880
Name:NIRVANA RECOVERY LLC
Entity type:Organization
Organization Name:NIRVANA RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:HILTON
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-256-4184
Mailing Address - Street 1:21725 N 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-2640
Mailing Address - Country:US
Mailing Address - Phone:602-662-2287
Mailing Address - Fax:480-427-6996
Practice Address - Street 1:15852 N 17TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-3365
Practice Address - Country:US
Practice Address - Phone:602-662-2287
Practice Address - Fax:480-427-6996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NIRVANA RECOVERY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder