Healthcare Provider Details

I. General information

NPI: 1245853522
Provider Name (Legal Business Name): RECOVERY INNOVATIONS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14554 LEE RD
CHANTILLY VA
20151-1775
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 602-650-1212
  • Fax: 602-650-1616
Mailing address:
  • Phone: 602-650-1212
  • Fax: 602-650-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

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