Provider Demographics
NPI:1316607658
Name:MILESTONE RECOVERY. LLC
Entity type:Organization
Organization Name:MILESTONE RECOVERY. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-300-0797
Mailing Address - Street 1:14001 N 7TH ST STE C106
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-4344
Mailing Address - Country:US
Mailing Address - Phone:602-612-3899
Mailing Address - Fax:
Practice Address - Street 1:14001 N 7TH ST STE C106
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-4344
Practice Address - Country:US
Practice Address - Phone:602-612-3899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility