MEDICARE: SUN VALLEY RECOVERY SERVICES 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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1790413748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN VALLEY RECOVERY SERVICES LLC

Provider Business Mailing Address
First Line	:	1076 W CHANDLER BLVD STE 113
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5205
Country	:	US
Telephone Number	:	480-809-6010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1076 W CHANDLER BLVD STE 113
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5205
Country	:	US
Telephone Number	:	480-809-6010
Fax Number	:	877-849-0021

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SEAN COOKE
Credential	:
Telephone Number	:	480-809-6010

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	08/09/2022

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Directions to “SUN VALLEY RECOVERY SERVICES LLC ” Practice Location

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