Provider Demographics
NPI:1912523549
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:
Practice Address - Street 1:3033 S ARIZONA AVE STE 110
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-2717
Practice Address - Country:US
Practice Address - Phone:800-922-0094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-19
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ082050Medicaid