Healthcare Provider Details

I. General information

NPI: 1811681695
Provider Name (Legal Business Name): HEALING HANDS RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 08/19/2023
Certification Date: 08/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 W CAMELBACK RD STE 110
PHOENIX AZ
85015-3463
US

IV. Provider business mailing address

1990 W CAMELBACK RD STE 110
PHOENIX AZ
85015-3463
US

V. Phone/Fax

Practice location:
  • Phone: 480-300-4651
  • Fax:
Mailing address:
  • Phone: 480-300-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: QUACY R MANNING
Title or Position: CEO
Credential:
Phone: 480-300-4651