Provider Demographics
NPI:1124779962
Name:GOLD METTLE RECOVERY, LLC
Entity type:Organization
Organization Name:GOLD METTLE RECOVERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-335-2859
Mailing Address - Street 1:12211 W BELL RD STE 106
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85378-9655
Mailing Address - Country:US
Mailing Address - Phone:480-808-5150
Mailing Address - Fax:602-975-3460
Practice Address - Street 1:12211 W BELL RD STE 106
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85378-9655
Practice Address - Country:US
Practice Address - Phone:480-808-5150
Practice Address - Fax:602-975-3460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty