Healthcare Provider Details

I. General information

NPI: 1417774167
Provider Name (Legal Business Name): HORIZON RECOVERY BUCKEYE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 04/12/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22190 W ASHLEIGH MARIE DR
BUCKEYE AZ
85326-8695
US

IV. Provider business mailing address

6635 W HAPPY VALLEY RD STE A104
GLENDALE AZ
85310-2609
US

V. Phone/Fax

Practice location:
  • Phone: 623-693-2198
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: BRIAN CARLISLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 623-693-2319