MEDICARE: MODERN RECOVERY, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1417636309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN RECOVERY, LLC

Provider Business Mailing Address
First Line	:	11445 E VIA LINDA STE 2-617
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85259-2655
Country	:	US
Telephone Number	:	602-694-9643
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 HOUSTON ST # 118
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76102-5004
Country	:	US
Telephone Number	:	203-200-8556
Fax Number	:

Authorized Official
Title or Position	:	BILLING DIRECTOR
Name	:	ANDREA STINER
Credential	:
Telephone Number	:	602-694-9643

Provider Enumeration Date	:	07/17/2023
Last Update Date	:	12/11/2025

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Directions to “MODERN RECOVERY, LLC ” Practice Location

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