Healthcare Provider Details

I. General information

NPI: 1811699622
Provider Name (Legal Business Name): COMFORT CARE RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 N ARIZONA AVE UNIT 1066
CHANDLER AZ
85225-0704
US

IV. Provider business mailing address

1255 N ARIZONA AVE UNIT 1066
CHANDLER AZ
85225-0704
US

V. Phone/Fax

Practice location:
  • Phone: 212-729-4221
  • Fax:
Mailing address:
  • Phone: 212-729-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARSHAREE CHEVAUGHN WILLIAMS
Title or Position: FOUNDER
Credential:
Phone: 212-729-4221