MEDICARE: RECOVERY INNOVATIONS, INC

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)
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1528660388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY INNOVATIONS, INC

Provider Business Mailing Address
First Line	:	2701 N 16TH ST STE 316
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-1266
Country	:	US
Telephone Number	:	602-650-1212
Fax Number	:

Provider Business Practice Location Address
First Line	:	3455 FLORIDA ST STE 500
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3764
Country	:	US
Telephone Number	:	602-650-1212
Fax Number	:

Authorized Official
Title or Position	:	ASSOCIATE DIRECTOR, CREDENTIALING
Name	:	CORINA OGAZ
Credential	:
Telephone Number	:	602-636-3085

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	06/29/2023

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