Healthcare Provider Details

I. General information

NPI: 1659035137
Provider Name (Legal Business Name): SHAMROCK RECOVERY SERVICES LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 09/02/2025
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 AINSWORTH DR STE B215
PRESCOTT AZ
86305-3411
US

IV. Provider business mailing address

1000 AINSWORTH DR STE B215
PRESCOTT AZ
86305-3411
US

V. Phone/Fax

Practice location:
  • Phone: 928-445-0744
  • Fax: 928-447-9911
Mailing address:
  • Phone: 928-445-0744
  • Fax: 928-447-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADAM FRANCIS ROGERS
Title or Position: OWNER
Credential: MA, LISAC
Phone: 928-830-1401