Healthcare Provider Details

I. General information

NPI: 1790553329
Provider Name (Legal Business Name): HEALING EDGE RECOVERY AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4220 N 20TH AVE STE 100
PHOENIX AZ
85015-5124
US

IV. Provider business mailing address

4120 N 108TH AVE STE 116
PHOENIX AZ
85037-5773
US

V. Phone/Fax

Practice location:
  • Phone: 623-872-1818
  • Fax: 623-872-1819
Mailing address:
  • Phone: 623-872-1818
  • Fax: 623-872-1819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: HARSIMRAN SINGH
Title or Position: PRESIDENT
Credential: MD
Phone: 623-872-1818