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NPI Code Detail

MEDICARE: PARTNERS IN RECOVERY, LLC

MEDICARE: PARTNERS IN RECOVERY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OTC13278OTHERAZARIZONA DEPARTMENT OF HEALTH SERVICES - LICENSING

General Provider Information

NPI Number : 1184476962
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARTNERS IN RECOVERY, LLC
Provider Business Mailing Address
First Line : 924 N COUNTRY CLUB DR
Second Line :
City : MESA
State : AZ
Zip : 85201-4108
Country : US
Telephone Number : 480-969-3800
Fax Number :
Provider Business Practice Location Address
First Line : 10217 N METRO PKWY W
Second Line :
City : PHOENIX
State : AZ
Zip : 85051-1438
Country : US
Telephone Number : 602-997-9006
Fax Number : 602-997-4585
Authorized Official
Title or Position : CHIEF RISK AND COMPLIANCE OFFICER
Name : LATRICE SHANNON HICKMAN
Credential :
Telephone Number : 480-431-9008
Provider Enumeration Date : 04/03/2024
Last Update Date : 08/14/2024

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