Healthcare Provider Details

I. General information

NPI: 1013749217
Provider Name (Legal Business Name): RECOVER SCOTTSDALE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7287 E EARLL DR BLDG D
SCOTTSDALE AZ
85251-7230
US

IV. Provider business mailing address

7287 E EARLL DR BLDG D
SCOTTSDALE AZ
85251-7230
US

V. Phone/Fax

Practice location:
  • Phone: 480-745-1713
  • Fax:
Mailing address:
  • Phone: 480-745-1713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: QUINN MCCULLOUGH
Title or Position: CEO
Credential:
Phone: 480-745-1713