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General NPI Number Information
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NPI Number | 1417636309
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Entity Type | Organization
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Legal Business Name | MODERN RECOVERY, LLC
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 702 HOUSTON ST # 118
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City | FORT WORTH
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State | TX
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Zip | 76102-5004
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Country | US
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Telephone | 203-200-8556
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Fax |
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Provider Business Mailing Address
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Address Line | 11445 E VIA LINDA STE 2-617
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-2655
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Country | US
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Telephone | 602-694-9643
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Fax |
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Authorized Official
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Title or Position | BILLING DIRECTOR
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Name | ANDREA STINER
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Credential |
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Telephone | 602-694-9643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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