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General NPI Number Information
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NPI Number | 1669119632
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Entity Type | Organization
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Legal Business Name | RENEE'S RESILIENCE RECOVERY
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Dates
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Enumeration Date | 05/19/2022
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 4040 E MCDOWELL RD STE 501
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City | PHOENIX
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State | AZ
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Zip | 85008-4478
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Country | US
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Telephone | 602-354-3326
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Fax |
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Provider Business Mailing Address
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Address Line | 1014 E GWEN ST
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City | PHOENIX
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State | AZ
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Zip | 85042-7870
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Country | US
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Telephone | 510-280-6632
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MITCHELL CLARDY
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Credential |
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Telephone | 510-290-6632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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