Healthcare Provider Details

I. General information

NPI: 1578002572
Provider Name (Legal Business Name): BUENA VISTA RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29858 N TATUM BLVD STE 110
CAVE CREEK AZ
85331-5865
US

IV. Provider business mailing address

8171 E INDIAN BEND RD STE 101
SCOTTSDALE AZ
85250-4830
US

V. Phone/Fax

Practice location:
  • Phone: 800-922-0094
  • Fax: 602-325-2082
Mailing address:
  • Phone: 800-922-0094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRISTINA HONIOTES
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 480-999-0851