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General NPI Number Information
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NPI Number | 1245772482
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Entity Type | Organization
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Legal Business Name | FOUNTAIN HILLS RECOVERY, LLC
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Dates
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Enumeration Date | 11/04/2016
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Last Update Date | 05/10/2017
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Provider Practice Location Address
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Address Line | 16872 E AVENUE OF THE FOUNTAINS SUITE 204
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-8312
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Country | US
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Telephone | 800-715-2004
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Fax | 480-476-8901
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Provider Business Mailing Address
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Address Line | 16872 E AVENUE OF THE FOUNTAINS SUITE 204
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-8312
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Country | US
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Telephone | 800-715-2004
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Fax | 480-476-8901
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Authorized Official
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Title or Position | OWNER
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Name | JOHN SALEM
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Credential |
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Telephone | 800-715-2004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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