Provider Demographics
NPI:1336031467
Name:MICRODOT RECOVERY LLC
Entity type:Organization
Organization Name:MICRODOT RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BHP
Authorized Official - Prefix:DR
Authorized Official - First Name:CHOLLETA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENJA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,PMHNP-BC
Authorized Official - Phone:480-232-8260
Mailing Address - Street 1:5723 W PUEBLO AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-6404
Mailing Address - Country:US
Mailing Address - Phone:480-232-8260
Mailing Address - Fax:602-225-2201
Practice Address - Street 1:5529 W PASEO WAY
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-3161
Practice Address - Country:US
Practice Address - Phone:480-232-8260
Practice Address - Fax:602-225-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-15
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility