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General NPI Number Information
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NPI Number | 1881990869
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Entity Type | Organization
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Legal Business Name | PERSONAL RECOVERY NETWORK LLC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 01/18/2025
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Provider Practice Location Address
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Address Line | 250 CORPORATE CENTER CT
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City | STOCKBRIDGE
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State | GA
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Zip | 30281
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Country | US
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Telephone | 770-389-8100
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Fax | 770-389-3030
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Provider Business Mailing Address
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Address Line | 4800 N SCOTTSDALE RD STE 2500
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-7630
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Country | US
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Telephone | 253-346-0392
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Fax | 770-389-3030
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Authorized Official
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Title or Position | LEGAL CHIEF OFFICER
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Name | RYAN PARDO
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Credential |
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Telephone | 206-399-1493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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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 | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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