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NPI Code Detail

MEDICARE: POWER RECOVERY CENTER, LLC

MEDICARE: POWER RECOVERY CENTER, 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2261QM1300XMulti-Specialty Clinic/Center
3261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1225618341
Entity Type Code : Organization
Provider Name (Legal Business Name) : POWER RECOVERY CENTER, LLC
Provider Business Mailing Address
First Line : 5625 W EUCLID AVE
Second Line :
City : LAVEEN
State : AZ
Zip : 85339-5247
Country : US
Telephone Number : 858-386-6705
Fax Number :
Provider Business Practice Location Address
First Line : 1137 W MCDOWELL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85007-1747
Country : US
Telephone Number : 480-572-8189
Fax Number : 480-546-3376
Authorized Official
Title or Position : OWNER
Name : TITUS KIMANI
Credential :
Telephone Number : 858-386-6705
Provider Enumeration Date : 04/12/2021
Last Update Date : 11/27/2024

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Directions to “POWER RECOVERY CENTER, LLC ” Practice Location

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