Healthcare Provider Details

I. General information

NPI: 1154257491
Provider Name (Legal Business Name): NIRVANA RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14034 N CORAL GABLES DR
PHOENIX AZ
85023-6277
US

IV. Provider business mailing address

21725 N 20TH AVE
PHOENIX AZ
85027-2640
US

V. Phone/Fax

Practice location:
  • Phone: 480-764-2335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CASEY STRAUSS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 480-764-2335