Healthcare Provider Details

I. General information

NPI: 1689147365
Provider Name (Legal Business Name): STAIRWAY RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2019
Last Update Date: 01/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 RIVERSIDE PLAZA LN NW STE 118 #96523
ALBUQUERQUE NM
87120
US

IV. Provider business mailing address

6300 RIVERSIDE PLAZA LN NW STE 118 #96523
ALBUQUERQUE NM
87120
US

V. Phone/Fax

Practice location:
  • Phone: 844-437-8247
  • Fax:
Mailing address:
  • Phone: 844-437-8247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET M WENGER
Title or Position: CEO
Credential: NP
Phone: 740-632-6383