Provider Demographics
NPI:1548981491
Name:CMJ RECOVERY AZ LLC
Entity type:Organization
Organization Name:CMJ RECOVERY AZ LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-345-5541
Mailing Address - Street 1:4122 N 17TH ST BLDG B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-5922
Mailing Address - Country:US
Mailing Address - Phone:866-313-5691
Mailing Address - Fax:602-899-8012
Practice Address - Street 1:4122 N 17TH ST BLDG C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5922
Practice Address - Country:US
Practice Address - Phone:866-313-5691
Practice Address - Fax:602-899-8012
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IFBH10302
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-08
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility