Provider Demographics
NPI:1699238279
Name:ARIZONA RECOVERY CENTER, INC
Entity type:Organization
Organization Name:ARIZONA RECOVERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:VONA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:289-733-5101
Mailing Address - Street 1:84 ACOMA BLVD N STE 104
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6096
Mailing Address - Country:US
Mailing Address - Phone:928-733-5101
Mailing Address - Fax:928-235-5588
Practice Address - Street 1:84 ACOMA BLVD N STE 104
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6096
Practice Address - Country:US
Practice Address - Phone:928-351-3030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty