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General NPI Number Information
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NPI Number | 1184193963
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Entity Type | Organization
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Legal Business Name | EMBARK RECOVERY LLC
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Dates
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Enumeration Date | 11/21/2018
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 1118 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1426
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Country | US
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Telephone | 877-215-2224
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Fax | 877-215-2224
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Provider Business Mailing Address
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Address Line | PO BOX 12341
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City | GLENDALE
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State | AZ
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Zip | 85318-2341
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Country | US
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Telephone | 877-215-2224
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Fax | 877-215-2224
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Authorized Official
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Title or Position | MANAGER
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Name | DAVID SLATTERY
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Credential |
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Telephone | 877-215-2224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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