Healthcare Provider Details

I. General information

NPI: 1881283414
Provider Name (Legal Business Name): APEX RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15650 N BLACK CANYON HWY STE 245B
PHOENIX AZ
85053-4041
US

IV. Provider business mailing address

15650 N BLACK CANYON HWY STE 245B
PHOENIX AZ
85053-4041
US

V. Phone/Fax

Practice location:
  • Phone: 602-292-2010
  • Fax:
Mailing address:
  • Phone: 602-292-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIC GLADE MAUGHAN
Title or Position: ADMINSTRATOR
Credential:
Phone: 602-292-2010