Provider Demographics
NPI:1962124503
Name:TRANSITIONAL RECOVERY SERVICES LLC
Entity type:Organization
Organization Name:TRANSITIONAL RECOVERY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO /OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNEAL
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:602-718-8809
Mailing Address - Street 1:5820 N 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-3088
Mailing Address - Country:US
Mailing Address - Phone:602-761-6221
Mailing Address - Fax:
Practice Address - Street 1:16165 N 83RD AVE STE 200
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5816
Practice Address - Country:US
Practice Address - Phone:602-761-6221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ174200000XMedicaid
AZ251B00000XMedicaid
AZ253200000XMedicaid
AZ261QM0850XMedicaid
AZ332800000XMedicaid
AZ104100000XMedicaid
AZ261QM0801XMedicaid
AZ101Y00000XMedicaid
AZ251S00000XMedicaid