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General NPI Number Information
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NPI Number | 1639857196
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Entity Type | Organization
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Legal Business Name | PROJECT RECOVERY OF ARIZONA, INC.
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Dates
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Enumeration Date | 07/06/2023
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 3438 N COUNTRY CLUB RD
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City | TUCSON
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State | AZ
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Zip | 85716-1257
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Country | US
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Telephone | 520-286-9964
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Fax |
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Provider Business Mailing Address
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Address Line | 3438 N COUNTRY CLUB RD
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City | TUCSON
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State | AZ
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Zip | 85716-1257
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Country | US
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Telephone | 520-286-9964
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Fax |
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Authorized Official
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Title or Position | CCO
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Name | CHARLES JACKSON
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Credential |
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Telephone | 480-787-1591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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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 | 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 #3
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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