MEDICARE: ARIZONA RECOVERY CENTER, INC

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
1	363L00000X	Nurse Practitioner
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1699238279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA RECOVERY CENTER, INC

Provider Business Mailing Address
First Line	:	84 ACOMA BLVD N STE 104
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6096
Country	:	US
Telephone Number	:	928-733-5101
Fax Number	:	928-235-5588

Provider Business Practice Location Address
First Line	:	84 ACOMA BLVD N STE 104
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403-6096
Country	:	US
Telephone Number	:	928-351-3030
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITONER/OWNER
Name	:	EMILY VONA
Credential	:	FNP-C
Telephone Number	:	289-733-5101

Provider Enumeration Date	:	04/10/2019
Last Update Date	:	01/15/2021

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