Provider Demographics
NPI:1093563538
Name:MONUMENT RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:MONUMENT RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:KETRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-299-5780
Mailing Address - Street 1:748 W 6TH DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2320
Mailing Address - Country:US
Mailing Address - Phone:480-299-5780
Mailing Address - Fax:480-613-5931
Practice Address - Street 1:748 W 6TH DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-2320
Practice Address - Country:US
Practice Address - Phone:480-299-5780
Practice Address - Fax:480-613-5931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility