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General NPI Number Information
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NPI Number | 1336031467
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Entity Type | Organization
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Legal Business Name | MICRODOT RECOVERY LLC
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Dates
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Enumeration Date | 07/15/2025
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Last Update Date | 07/15/2025
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Provider Practice Location Address
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Address Line | 5529 W PASEO WAY
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City | LAVEEN
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State | AZ
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Zip | 85339-3161
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Country | US
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Telephone | 480-232-8260
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Fax | 602-225-2201
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Provider Business Mailing Address
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Address Line | 5723 W PUEBLO AVE
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City | PHOENIX
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State | AZ
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Zip | 85043-6404
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Country | US
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Telephone | 480-232-8260
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Fax | 602-225-2201
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Authorized Official
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Title or Position | BHP
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Name | DR. CHOLLETA MENJA
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Credential | DNP,PMHNP-BC
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Telephone | 480-232-8260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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