Healthcare Provider Details

I. General information

NPI: 1306475751
Provider Name (Legal Business Name): PARAMOUNT RECOVERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

637 W HILLSIDE AVE
PRESCOTT AZ
86301-1909
US

IV. Provider business mailing address

637 W HILLSIDE AVE
PRESCOTT AZ
86301-1909
US

V. Phone/Fax

Practice location:
  • Phone: 928-370-3523
  • Fax: 866-868-3056
Mailing address:
  • Phone: 928-222-1485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN ROSS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 917-903-7445