MEDICARE: GRACEWARD RECOVERY

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility
3	347C00000X	Private Vehicle
4	251B00000X	Case Management Agency
5	261QM2500X	Medical Specialty Clinic/Center
6	103TA0400X	Addiction (Substance Use Disorder) Psychologist
7	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
8	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
9	343900000X	Non-emergency Medical Transport (VAN)
10	251S00000X	Community/Behavioral Health Agency

NPI Number	:	1114702420
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRACEWARD RECOVERY

Provider Business Mailing Address
First Line	:	9700 N 91ST ST STE A115
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-5036
Country	:	US
Telephone Number	:	623-246-4900
Fax Number	:

Provider Business Practice Location Address
First Line	:	9700 N 91ST ST STE A115
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-5036
Country	:	US
Telephone Number	:	623-246-4900
Fax Number	:	480-806-2832

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MICAH DAMON HALE
Credential	:	DO
Telephone Number	:	831-818-9833

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	05/23/2026

9700 N 91ST ST STE B108
SCOTTSDALE, AZ
85258-5036

Practice Phone: 480-534-4544
Practice Fax: 602-258-8510