Healthcare Provider Details

I. General information

NPI: 1962345900
Provider Name (Legal Business Name): DESERT RECOVERY CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 N 108TH AVE STE 101
PHOENIX AZ
85037-5468
US

IV. Provider business mailing address

4160 N 108TH AVE STE 101
PHOENIX AZ
85037-5468
US

V. Phone/Fax

Practice location:
  • Phone: 602-332-8889
  • Fax: 623-399-1015
Mailing address:
  • Phone: 602-550-3565
  • Fax: 623-399-1015

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: AN NGUYEN
Title or Position: OWNER
Credential: MD
Phone: 602-332-8889