Healthcare Provider Details

I. General information

NPI: 1013404680
Provider Name (Legal Business Name): CONTINUUM RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 04/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 W GREENWAY RD STE 104
PHOENIX AZ
85053-3729
US

IV. Provider business mailing address

3710 W GREENWAY RD STE 104
PHOENIX AZ
85053-3729
US

V. Phone/Fax

Practice location:
  • Phone: 602-466-2036
  • Fax: 602-993-5648
Mailing address:
  • Phone: 602-466-2036
  • Fax: 602-993-5648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANE AYALA-COOK
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-466-2036