Healthcare Provider Details

I. General information

NPI: 1851667257
Provider Name (Legal Business Name): CHAPTER 5 RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W GURLEY ST
PRESCOTT AZ
86305
US

IV. Provider business mailing address

709 W GURLEY ST
PRESCOTT AZ
86305
US

V. Phone/Fax

Practice location:
  • Phone: 928-708-9615
  • Fax: 928-708-9620
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberBH-4015
License Number StateAZ

VIII. Authorized Official

Name: MR. MATTHEW FRANCIS LUCHINI
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 928-533-4220