Provider Demographics
NPI:1104455534
Name:FOUNTAIN HILLS RECOVERY, LLC
Entity type:Organization
Organization Name:FOUNTAIN HILLS RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-476-8912
Mailing Address - Street 1:16872 E AVENUE OF THE FOUNTAINS STE 204
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-8314
Mailing Address - Country:US
Mailing Address - Phone:480-476-8900
Mailing Address - Fax:480-476-8901
Practice Address - Street 1:7210 E DALE LN
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85266-8120
Practice Address - Country:US
Practice Address - Phone:480-476-8900
Practice Address - Fax:480-476-8901
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FOUNTAIN HILLS RECOVERY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-07
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1245772482OtherSUBSTANCE ABUSE