Healthcare Provider Details

I. General information

NPI: 1164799987
Provider Name (Legal Business Name): NAZCARE, INC POWER RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2011
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

367 N MAIN ST
EAGAR AZ
85925-9675
US

IV. Provider business mailing address

599 WHITE SPAR RD
PRESCOTT AZ
86303-4627
US

V. Phone/Fax

Practice location:
  • Phone: 928-333-4990
  • Fax: 928-649-9394
Mailing address:
  • Phone: 928-442-9205
  • Fax: 928-442-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License NumberCSA03NA0148
License Number StateAZ

VIII. Authorized Official

Name: MS. ROBERTA LYNNE HOWARD
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MA, LCS, BHT
Phone: 928-442-9205