Healthcare Provider Details

I. General information

NPI: 1306756754
Provider Name (Legal Business Name): MERIDIAN WELLNESS AND RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 S LAKESHORE DR SUITE 207
TEMPE AZ
85282
US

IV. Provider business mailing address

4801 S LAKESHORE DR SUITE 207
TEMPE AZ
85282
US

V. Phone/Fax

Practice location:
  • Phone: 562-659-0950
  • Fax: 310-974-4296
Mailing address:
  • Phone: 562-659-0950
  • Fax: 310-974-4296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEIONNA GIPSON
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 562-659-0950