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General NPI Number Information
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NPI Number | 1174399497
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Entity Type | Organization
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Legal Business Name | ROCK RECOVERY
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 11/28/2023
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Provider Practice Location Address
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Address Line | 13223 W ASHWOOD DR
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-4510
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Country | US
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Telephone | 623-301-2404
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Fax | 623-462-2525
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Provider Business Mailing Address
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Address Line | 13223 W ASHWOOD DR
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City | SUN CITY WEST
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State | AZ
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Zip | 85375-4510
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Country | US
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Telephone | 623-734-7605
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | PROF. JEFFREY JAY HOSTETLER
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Credential | RN,BSN,
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Telephone | 623-734-7605
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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