Healthcare Provider Details

I. General information

NPI: 1558988246
Provider Name (Legal Business Name): CMJ RECOVERY AZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1590 S CONGRESS AVE
PALM SPRINGS FL
33406-5957
US

V. Phone/Fax

Practice location:
  • Phone: 818-304-8071
  • Fax:
Mailing address:
  • Phone: 847-345-5541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JANICE VAYSBERG
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 847-345-5541