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General NPI Number Information
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NPI Number | 1669289880
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Entity Type | Organization
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Legal Business Name | NIRVANA RECOVERY LLC
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Dates
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Enumeration Date | 12/11/2024
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 15852 N 17TH ST
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City | PHOENIX
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State | AZ
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Zip | 85022-3365
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Country | US
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Telephone | 602-662-2287
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Fax | 480-427-6996
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Provider Business Mailing Address
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Address Line | 21725 N 20TH AVE
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City | PHOENIX
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State | AZ
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Zip | 85027-2640
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Country | US
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Telephone | 480-764-2335
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MICHAEL TRYCHON
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Credential |
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Telephone | 602-471-2152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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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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