Provider Demographics
| NPI: | 1669986998 |
|---|---|
| Name: | WD RECOVERY AND WELLNESS CENTER, LLC |
| Entity type: | Organization |
| Organization Name: | WD RECOVERY AND WELLNESS CENTER, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | ADMINISTRATOR |
| Authorized Official - Prefix: | MISS |
| Authorized Official - First Name: | OCEAN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | WOLPERT |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 602-732-1151 |
| Mailing Address - Street 1: | 6520 N 7TH ST STE 200 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | PHOENIX |
| Mailing Address - State: | AZ |
| Mailing Address - Zip Code: | 85014-1239 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 480-681-0454 |
| Mailing Address - Fax: | 480-681-0449 |
| Practice Address - Street 1: | 6520 N 7TH ST STE 100 |
| Practice Address - Street 2: | |
| Practice Address - City: | PHOENIX |
| Practice Address - State: | AZ |
| Practice Address - Zip Code: | 85014-1213 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 480-681-0454 |
| Practice Address - Fax: | 480-681-0449 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2017-11-22 |
| Last Update Date: | 2025-05-05 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 133N00000X | Dietary & Nutritional Service Providers | Nutritionist | Group - Multi-Specialty | |
| No | 133NN1002X | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | Group - Multi-Specialty |
| No | 164X00000X | Nursing Service Providers | Licensed Vocational Nurse | Group - Multi-Specialty | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Multi-Specialty |
| No | 261QR0800X | Ambulatory Health Care Facilities | Clinic/Center | Recovery Care | Group - Multi-Specialty |
| No | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Group - Multi-Specialty |
