Provider Demographics
NPI:1548914534
Name:PARTNERS IN RECOVERY OUTPATIENT CENTER, LLC
Entity type:Organization
Organization Name:PARTNERS IN RECOVERY OUTPATIENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASIA
Authorized Official - Middle Name:MONDAE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-675-1289
Mailing Address - Street 1:3201 W PEORIA AVE STE B408
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-4610
Mailing Address - Country:US
Mailing Address - Phone:602-675-1289
Mailing Address - Fax:
Practice Address - Street 1:3201 W PEORIA AVE STE B408
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-4610
Practice Address - Country:US
Practice Address - Phone:602-675-1289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)