MEDICARE: WELLNESS AND RECOVERY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1134967177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS AND RECOVERY

Provider Business Mailing Address
First Line	:	4321 E SAINT ANNE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5232
Country	:	US
Telephone Number	:	602-466-4696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2510 E PLEASANT LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-5161
Country	:	US
Telephone Number	:	602-466-4696
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. RODNEY SHEPPARD SR.
Credential	:	PRSS
Telephone Number	:	602-466-4696

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	09/01/2024

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Directions to “WELLNESS AND RECOVERY ” Practice Location

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