Healthcare Provider Details

I. General information

NPI: 1447922448
Provider Name (Legal Business Name): UTURN TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 S 51ST ST STE 125
PHOENIX AZ
85044-5226
US

IV. Provider business mailing address

10201 S 51ST ST STE 125
PHOENIX AZ
85044-5226
US

V. Phone/Fax

Practice location:
  • Phone: 602-475-8702
  • Fax:
Mailing address:
  • Phone: 602-475-8702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON BORUM
Title or Position: PRESIDENT/CEO
Credential:
Phone: 602-475-8702