Healthcare Provider Details

I. General information

NPI: 1013448489
Provider Name (Legal Business Name): ADDICTION RECOVERY CENTERS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S RANCHO DR SUITE H-50
LAS VEGAS NV
89106-4828
US

IV. Provider business mailing address

501 S RANCHO DR SUITE H-50
LAS VEGAS NV
89106-4828
US

V. Phone/Fax

Practice location:
  • Phone: 702-919-0000
  • Fax: 702-476-9411
Mailing address:
  • Phone: 702-919-0000
  • Fax: 702-476-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number16973
License Number StateNV

VIII. Authorized Official

Name: DR. MICHAEL GENOVESE
Title or Position: EXECUTIVE MEDICAL DIRECTOR
Credential: M.D., J.D.
Phone: 702-919-0000