Healthcare Provider Details

I. General information

NPI: 1699238279
Provider Name (Legal Business Name): ARIZONA RECOVERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 ACOMA BLVD N STE 104
LAKE HAVASU CITY AZ
86403-6096
US

IV. Provider business mailing address

84 ACOMA BLVD N STE 104
LAKE HAVASU CITY AZ
86403-6096
US

V. Phone/Fax

Practice location:
  • Phone: 928-351-3030
  • Fax:
Mailing address:
  • Phone: 928-733-5101
  • Fax: 928-235-5588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY VONA
Title or Position: NURSE PRACTITONER/OWNER
Credential: FNP-C
Phone: 289-733-5101