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General NPI Number Information
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NPI Number | 1477212306
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Entity Type | Organization
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Legal Business Name | NORTHSIGHT RECOVERY LLC
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 1440 E SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-5612
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Country | US
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Telephone | 480-544-0283
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Fax |
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Provider Business Mailing Address
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Address Line | 10441 E THATCHER AVE
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City | MESA
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State | AZ
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Zip | 85212-8338
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Country | US
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Telephone | 480-544-0283
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Fax |
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Authorized Official
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Title or Position | MEMBER/CEO
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Name | JEREMY BLOOM
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Credential |
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Telephone | 480-544-0283
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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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 #6
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #8
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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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