Healthcare Provider Details

I. General information

NPI: 1427360734
Provider Name (Legal Business Name): RECOVERY INNOVATIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S 333RD ST
FEDERAL WAY WA
98003-6343
US

IV. Provider business mailing address

2601 N 16TH ST STE 316
PHOENIX AZ
85006-1404
US

V. Phone/Fax

Practice location:
  • Phone: 602-650-1212
  • Fax:
Mailing address:
  • Phone: 602-650-1212
  • Fax: 602-636-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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