Healthcare Provider Details

I. General information

NPI: 1124717517
Provider Name (Legal Business Name): MONUMENT RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W BROWN RD STE 2001
MESA AZ
85201-3229
US

IV. Provider business mailing address

560 W BROWN RD STE 2001
MESA AZ
85201-3229
US

V. Phone/Fax

Practice location:
  • Phone: 480-331-3367
  • Fax: 480-613-5931
Mailing address:
  • Phone: 480-331-3367
  • Fax: 480-613-5931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN KETRON
Title or Position: FOUNDER AND CEO
Credential:
Phone: 480-299-5780