Healthcare Provider Details

I. General information

NPI: 1588203525
Provider Name (Legal Business Name): LIFE RECOVERY HEALTHCARE SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2019
Last Update Date: 12/21/2019
Certification Date: 12/21/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 E RIO SALADO PKWY STE 900
TEMPE AZ
85281-9126
US

IV. Provider business mailing address

8194 W DEER VALLEY RD STE 505
PEORIA AZ
85382-2127
US

V. Phone/Fax

Practice location:
  • Phone: 623-335-2628
  • Fax:
Mailing address:
  • Phone: 623-335-2628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code364SP0812X
TaxonomyCommunity Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PAMELA ROBINSON
Title or Position: EXEC. MEDICAL DIRECTOR
Credential: PSYD, NP
Phone: 602-427-7432