Healthcare Provider Details

I. General information

NPI: 1639857196
Provider Name (Legal Business Name): PROJECT RECOVERY OF ARIZONA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3438 N COUNTRY CLUB RD
TUCSON AZ
85716-1257
US

IV. Provider business mailing address

3438 N COUNTRY CLUB RD
TUCSON AZ
85716-1257
US

V. Phone/Fax

Practice location:
  • Phone: 520-286-9964
  • Fax:
Mailing address:
  • Phone: 520-286-9964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARLES JACKSON
Title or Position: CCO
Credential:
Phone: 480-787-1591