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General NPI Number Information
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NPI Number | 1508207523
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Entity Type | Organization
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Legal Business Name | RECOVERY IN THE PINES, LLC
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 06/23/2015
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Provider Practice Location Address
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Address Line | 919 12TH PLACE #13
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City | PRESCOTT
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State | AZ
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Zip | 86305
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Country | US
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Telephone | 928-227-2967
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Fax | 928-227-2968
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Provider Business Mailing Address
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Address Line | 919 12TH PLACE #13
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City | PRESCOTT
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State | AZ
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Zip | 86305
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Country | US
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Telephone | 928-227-2967
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Fax | 928-227-2968
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALBERT BLACK
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Credential |
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Telephone | 928-308-4311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CSLG6504
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License Number State | AZ
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