Provider Demographics
NPI:1700265089
Name:ARCADIA RECOVERY CENTER
Entity Type:Organization
Organization Name:ARCADIA RECOVERY CENTER
Other - Org Name:BLACK ROCK RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:RAS
Authorized Official - Phone:801-709-9419
Mailing Address - Street 1:1188 VICTORIAN PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-4943
Mailing Address - Country:US
Mailing Address - Phone:800-535-9041
Mailing Address - Fax:877-898-8799
Practice Address - Street 1:1188 VICTORIAN PLAZA CIR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-4943
Practice Address - Country:US
Practice Address - Phone:800-535-9041
Practice Address - Fax:877-898-8799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 1041C0700X
NV261QR0405X, 283Q00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No283Q00000XHospitalsPsychiatric Hospital