Healthcare Provider Details

I. General information

NPI: 1366130536
Provider Name (Legal Business Name): ADDICTED TO RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 N COUNTRY CLUB RD
TUCSON AZ
85716-1911
US

IV. Provider business mailing address

15650 N BLACK CANYON HWY STE 245B
PHOENIX AZ
85053-4041
US

V. Phone/Fax

Practice location:
  • Phone: 602-292-2010
  • Fax:
Mailing address:
  • Phone: 602-292-2010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ERIC MAUGHAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 602-292-2010