Healthcare Provider Details

I. General information

NPI: 1952259665
Provider Name (Legal Business Name): PROJECT IMPACT RECOVERY AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 N CENTENNIAL WAY STE 101
MESA AZ
85201-6733
US

IV. Provider business mailing address

303 N CENTENNIAL WAY STE 101
MESA AZ
85201-6733
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-8600
  • Fax: 480-269-9700
Mailing address:
  • Phone: 480-269-8600
  • Fax: 480-269-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JASON CHAPMAN
Title or Position: CEO
Credential:
Phone: 480-772-7537