Healthcare Provider Details

I. General information

NPI: 1801639646
Provider Name (Legal Business Name): HORIZON RECOVERY OUTPATIENT ARROWHEAD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 W UNION HILLS DR STE B100
GLENDALE AZ
85308-1313
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 TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRIAN CARLISLE
Title or Position: ADMINISTRATOR
Credential: FNP-C
Phone: 623-693-2198