MEDICARE: WINR WOMEN IN NEW RECOVERY

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	BH-2306	AZ

General Provider Information

NPI Number	:	1972774685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINR WOMEN IN NEW RECOVERY

Provider Business Mailing Address
First Line	:	860 N CENTER ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-4201
Country	:	US
Telephone Number	:	480-464-5764
Fax Number	:	480-834-5372

Provider Business Practice Location Address
First Line	:	860 N CENTER ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85201-4201
Country	:	US
Telephone Number	:	480-464-5764
Fax Number	:	480-834-5372

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. PATRICIA A HENDERSON
Credential	:
Telephone Number	:	480-464-5764

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	07/24/2008

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