MEDICARE: PHOENIX RECOVERY HOMES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1588346753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHOENIX RECOVERY HOMES

Provider Business Mailing Address
First Line	:	961 W FOGAL WAY
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-4727
Country	:	US
Telephone Number	:	480-459-4936
Fax Number	:	602-532-7076

Provider Business Practice Location Address
First Line	:	961 W FOGAL WAY
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-4727
Country	:	US
Telephone Number	:	480-459-4936
Fax Number	:	602-532-7076

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ANDREW KISEKKA
Credential	:
Telephone Number	:	661-289-2180

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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Directions to “PHOENIX RECOVERY HOMES ” Practice Location

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