Provider Demographics
NPI:1487767760
Name:RECOVERY EMPOWERMENT NETWORK OF MARICOPA COUNTY
Entity type:Organization
Organization Name:RECOVERY EMPOWERMENT NETWORK OF MARICOPA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW CPRP
Authorized Official - Phone:602-248-0368
Mailing Address - Street 1:PO BOX 7732
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011-7732
Mailing Address - Country:US
Mailing Address - Phone:602-248-0368
Mailing Address - Fax:602-266-1958
Practice Address - Street 1:333 W INDIAN SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013
Practice Address - Country:US
Practice Address - Phone:602-248-0368
Practice Address - Fax:602-266-1958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZCSA06ADHS0187OtherDBHS
AZ07B523Medicare ID - Type Unspecified