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NPI Code Detail

MEDICARE: LIFE RECOVERY HEALTHCARE SYSTEMS INC

MEDICARE: LIFE RECOVERY HEALTHCARE SYSTEMS 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
1103TA0400XAddiction (Substance Use Disorder) Psychologist
2251S00000XCommunity/Behavioral Health Agency
3261QC1500XCommunity Health Clinic/Center
4261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
5261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
6364SP0812XCommunity Psychiatric/Mental Health Clinical Nurse Specialist
7261QH0100XHealth Service Clinic/Center

General Provider Information

NPI Number : 1588203525
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFE RECOVERY HEALTHCARE SYSTEMS INC
Provider Business Mailing Address
First Line : 8194 W DEER VALLEY RD STE 505
Second Line :
City : PEORIA
State : AZ
Zip : 85382-2127
Country : US
Telephone Number : 623-335-2628
Fax Number :
Provider Business Practice Location Address
First Line : 60 E RIO SALADO PKWY STE 900
Second Line :
City : TEMPE
State : AZ
Zip : 85281-9126
Country : US
Telephone Number : 623-335-2628
Fax Number :
Authorized Official
Title or Position : EXEC. MEDICAL DIRECTOR
Name : DR. PAMELA ROBINSON
Credential : PSYD, NP
Telephone Number : 602-427-7432
Provider Enumeration Date : 12/21/2019
Last Update Date : 12/21/2019

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