MEDICARE: EMBERS OUTPATIENT LLC

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1275334039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBERS OUTPATIENT LLC

Provider Business Mailing Address
First Line	:	4202 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-4219
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4202 N 44TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-4219
Country	:	US
Telephone Number	:	978-548-7328
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ANTONY PAYNE
Credential	:
Telephone Number	:	978-548-7328

Provider Enumeration Date	:	03/19/2025
Last Update Date	:	03/19/2025

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Directions to “EMBERS OUTPATIENT LLC ” Practice Location

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