MEDICARE: TRAUMA PREVENTION AND RECOVERY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	251B00000X	Case Management Agency
3	261Q00000X	Clinic/Center
4	261QM0850X	Adult Mental Health Clinic/Center
5	261QM0855X	Adolescent and Children Mental Health Clinic/Center
6	261QM1300X	Multi-Specialty Clinic/Center
7	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
8	320800000X	Mental Illness Community Based Residential Treatment Facility
9	385H00000X	Respite Care
10	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1396498812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAUMA PREVENTION AND RECOVERY LLC

Provider Business Mailing Address
First Line	:	4504 E WOOD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-9204
Country	:	US
Telephone Number	:	480-577-8164
Fax Number	:

Provider Business Practice Location Address
First Line	:	1137 W MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85007-1747
Country	:	US
Telephone Number	:	480-577-8164
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIERRA NATE ABDULLAH
Credential	:
Telephone Number	:	480-577-8164

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	09/27/2024

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