Healthcare Provider Details

I. General information

NPI: 1437969482
Provider Name (Legal Business Name): RENEWAL RECOVERY HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2025
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7437 S 22ND AVE
PHOENIX AZ
85041-5472
US

IV. Provider business mailing address

7437 S 22ND AVE
PHOENIX AZ
85041-5472
US

V. Phone/Fax

Practice location:
  • Phone: 520-542-2056
  • Fax: 480-248-2682
Mailing address:
  • Phone: 520-542-2056
  • Fax: 480-248-2682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. GLORIA J HARRIS
Title or Position: OWNER
Credential: LISAC, LAC
Phone: 520-280-8009