Provider Demographics
NPI:1861180127
Name:SHAMMAH RECOVERY CENTER,LLC
Entity type:Organization
Organization Name:SHAMMAH RECOVERY CENTER,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NSHIMIRIMANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-332-3769
Mailing Address - Street 1:21362 W BERKELEY RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-2449
Mailing Address - Country:US
Mailing Address - Phone:520-332-3769
Mailing Address - Fax:
Practice Address - Street 1:2224 W NORTHERN AVE STE D265
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-5753
Practice Address - Country:US
Practice Address - Phone:520-332-3769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)