MEDICARE: RESILIENT DIGNITY RECOVERY COMMUNITY CO-OP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	251B00000X	Case Management Agency
3	251S00000X	Community/Behavioral Health Agency
4	261QE0002X	Emergency Care Clinic/Center
5	320800000X	Mental Illness Community Based Residential Treatment Facility
6	323P00000X	Psychiatric Residential Treatment Facility
7	385H00000X	Respite Care
8	251V00000X	Voluntary or Charitable Agency
9	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1861202889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESILIENT DIGNITY RECOVERY COMMUNITY CO-OP INC

Provider Business Mailing Address
First Line	:	220 N 12TH ST UNIT 248
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-1385
Country	:	US
Telephone Number	:	602-757-6346
Fax Number	:

Provider Business Practice Location Address
First Line	:	1333 N 24TH ST APT 214
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4674
Country	:	US
Telephone Number	:	602-757-6346
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MARIA PETRARU
Credential	:
Telephone Number	:	602-757-6346

Provider Enumeration Date	:	01/10/2025
Last Update Date	:	01/10/2025

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