Provider Demographics
NPI:1053946095
Name:RECOVERY INNOVATIONS INC
Entity type:Organization
Organization Name:RECOVERY INNOVATIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTRACTS AND RATES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DEPRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-636-4452
Mailing Address - Street 1:2701 N 16TH ST STE 316
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1266
Mailing Address - Country:US
Mailing Address - Phone:602-650-1212
Mailing Address - Fax:602-650-1616
Practice Address - Street 1:2411 S 1070 W STE B
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-1570
Practice Address - Country:US
Practice Address - Phone:602-650-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-10
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility