Healthcare Provider Details

I. General information

NPI: 1396080909
Provider Name (Legal Business Name): RECOVERY INNOVATIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737 ATLANTA AVE STE H5
RIVERSIDE CA
92507-2419
US

IV. Provider business mailing address

2701 N 16TH ST STE 316
PHOENIX AZ
85006-1266
US

V. Phone/Fax

Practice location:
  • Phone: 951-686-5484
  • Fax:
Mailing address:
  • Phone: 602-636-1212
  • Fax: 602-650-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CORINA OGAZ
Title or Position: ASSOCIATE DIRECTOR, CREDENTIALING
Credential:
Phone: 602-636-3085