Provider Demographics
NPI:1053979724
Name:BUENA VISTA RECOVERY, LLC
Entity type:Organization
Organization Name:BUENA VISTA RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HONIOTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-999-0851
Mailing Address - Street 1:8171 E INDIAN BEND RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4830
Mailing Address - Country:US
Mailing Address - Phone:800-922-0094
Mailing Address - Fax:623-471-8348
Practice Address - Street 1:3033 S ARIZONA AVE STE 110
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-2717
Practice Address - Country:US
Practice Address - Phone:623-256-4184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUENA VISTA RECOVERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-29
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No291U00000XLaboratoriesClinical Medical Laboratory
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ591738Medicaid