Provider Demographics
NPI:1861202889
Name:RESILIENT DIGNITY RECOVERY COMMUNITY CO-OP INC
Entity type:Organization
Organization Name:RESILIENT DIGNITY RECOVERY COMMUNITY CO-OP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRARU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-757-6346
Mailing Address - Street 1:220 N 12TH ST UNIT 248
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-1385
Mailing Address - Country:US
Mailing Address - Phone:602-757-6346
Mailing Address - Fax:
Practice Address - Street 1:1333 N 24TH ST APT 214
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4674
Practice Address - Country:US
Practice Address - Phone:602-757-6346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No385H00000XRespite Care FacilityRespite Care
No251V00000XAgenciesVoluntary or Charitable