Healthcare Provider Details

I. General information

NPI: 1548981491
Provider Name (Legal Business Name): CMJ RECOVERY AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2022
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 N 17TH ST BLDG C
PHOENIX AZ
85016-5922
US

IV. Provider business mailing address

4122 N 17TH ST BLDG B
PHOENIX AZ
85016-5922
US

V. Phone/Fax

Practice location:
  • Phone: 866-313-5691
  • Fax: 602-899-8012
Mailing address:
  • Phone: 866-313-5691
  • Fax: 602-899-8012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental 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: BRUCE WORTHINGTON
Title or Position: DIRECTOR, REVENUE CYCLE MANAGEMENT
Credential: MBA
Phone: 561-858-8263