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General NPI Number Information
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NPI Number | 1871294843
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Entity Type | Organization
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Legal Business Name | PARADISE RECOVERY COMMUNITY CENTER,LLC
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Dates
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Enumeration Date | 03/15/2023
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Last Update Date | 03/15/2023
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Provider Practice Location Address
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Address Line | 18428 W MIAMI ST STE 18428
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City | GOODYEAR
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State | AZ
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Zip | 85338-7490
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Country | US
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Telephone | 623-202-9583
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Fax | 623-882-0715
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Provider Business Mailing Address
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Address Line | 18428 W MIAMI ST STE 18428
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City | GOODYEAR
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State | AZ
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Zip | 85338-7490
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Country | US
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Telephone | 623-202-9583
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Fax | 623-882-0715
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | KENNEDY AMUGHAN
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Credential | N/A
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Telephone | 623-202-9583
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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 |
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License Number State |
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