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General NPI Number Information
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NPI Number | 1336007574
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Entity Type | Organization
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Legal Business Name | SECOND LIGHT RECOVERY LLC
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Dates
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Enumeration Date | 01/15/2026
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Last Update Date | 01/15/2026
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Provider Practice Location Address
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Address Line | 16036 N 159TH LN
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City | SURPRISE
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State | AZ
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Zip | 85374-5864
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Country | US
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Telephone | 602-892-4940
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Fax |
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Provider Business Mailing Address
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Address Line | 16036 N 159TH LN
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City | SURPRISE
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State | AZ
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Zip | 85374-5864
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CONSULTANT
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Name | TONY RENELLO
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Credential |
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Telephone | 480-606-8602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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