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General NPI Number Information
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NPI Number | 1952807414
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Entity Type | Organization
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Legal Business Name | HOLDFAST RECOVERY
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Dates
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Enumeration Date | 04/03/2018
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 1579 W GURLEY ST
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City | PRESCOTT
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State | AZ
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Zip | 86305-2829
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Country | US
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Telephone | 928-925-7856
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Fax |
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Provider Business Mailing Address
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Address Line | 1579 W GURLEY ST
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City | PRESCOTT
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State | AZ
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Zip | 86305-2829
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Country | US
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Telephone | 800-351-6858
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRENDAN JAMES MCDONOUGH
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Credential |
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Telephone | 928-589-4617
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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 | 276400000X
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Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
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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 | 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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