Healthcare Provider Details

I. General information

NPI: 1104455534
Provider Name (Legal Business Name): FOUNTAIN HILLS RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 E DALE LN
SCOTTSDALE AZ
85266-8120
US

IV. Provider business mailing address

16872 E AVENUE OF THE FOUNTAINS STE 204
FOUNTAIN HILLS AZ
85268-8314
US

V. Phone/Fax

Practice location:
  • Phone: 480-476-8900
  • Fax: 480-476-8901
Mailing address:
  • Phone: 480-476-8900
  • Fax: 480-476-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN SALEM
Title or Position: ADMIN
Credential:
Phone: 480-476-8912