Healthcare Provider Details

I. General information

NPI: 1477973170
Provider Name (Legal Business Name): AWAKENING RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E BASELINE RD SUITE 208
TEMPE AZ
85283-1454
US

IV. Provider business mailing address

1204 E BASELINE RD SUITE 208
TEMPE AZ
85283-1454
US

V. Phone/Fax

Practice location:
  • Phone: 480-209-1977
  • Fax:
Mailing address:
  • Phone: 480-209-1977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberCSLG7734
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLISAC-10360
License Number StateAZ

VIII. Authorized Official

Name: PROF. SCOTT PAYNE RICHARD
Title or Position: CERTIFIED PROFESSIONAL COUNSELOR
Credential: LISAC
Phone: 480-209-1977