Provider Demographics
NPI:1750929865
Name:BUENA VISTA RECOVERY, LLC
Entity type:Organization
Organization Name:BUENA VISTA RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HONIOTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-999-0851
Mailing Address - Street 1:8171 E INDIAN BEND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4830
Mailing Address - Country:US
Mailing Address - Phone:800-922-0094
Mailing Address - Fax:877-215-2224
Practice Address - Street 1:5151 E PIMA ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3627
Practice Address - Country:US
Practice Address - Phone:877-215-2224
Practice Address - Fax:877-215-2224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUENA VISTA RECOVERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-19
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No291U00000XLaboratoriesClinical Medical Laboratory
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ004166Medicaid