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General NPI Number Information
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NPI Number | 1134967177
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Entity Type | Organization
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Legal Business Name | WELLNESS AND RECOVERY
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Dates
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Enumeration Date | 07/15/2024
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Last Update Date | 09/01/2024
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Provider Practice Location Address
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Address Line | 2510 E PLEASANT LN
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City | PHOENIX
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State | AZ
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Zip | 85042-5161
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Country | US
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Telephone | 602-466-4696
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Fax |
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Provider Business Mailing Address
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Address Line | 4321 E SAINT ANNE AVE
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City | PHOENIX
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State | AZ
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Zip | 85042-5232
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Country | US
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Telephone | 602-466-4696
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. RODNEY SHEPPARD SR.
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Credential | PRSS
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Telephone | 602-466-4696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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