Healthcare Provider Details

I. General information

NPI: 1922396639
Provider Name (Legal Business Name): SCOTTSDALE RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10446 N 74TH ST STE 150
SCOTTSDALE AZ
85258-1045
US

IV. Provider business mailing address

10446 N. 74TH ST. SUITE 150
SCOTTSDALE AZ
85258
US

V. Phone/Fax

Practice location:
  • Phone: 480-699-9044
  • Fax: 480-284-6749
Mailing address:
  • Phone: 480-699-9044
  • Fax: 480-284-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberOTC7795
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberOTC7795
License Number StateAZ

VIII. Authorized Official

Name: MR. CHRIS COHN
Title or Position: OWNER
Credential:
Phone: 602-478-3210