Provider Demographics
NPI:1962184747
Name:UNION RECOVERY CENTER
Entity type:Organization
Organization Name:UNION RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAYIJAMAHE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAKERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-546-3216
Mailing Address - Street 1:7170 W CAMINO SAN XAVIER BLDG C
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0833
Mailing Address - Country:US
Mailing Address - Phone:832-546-3216
Mailing Address - Fax:
Practice Address - Street 1:7170 W CAMINO SAN XAVIER BLDG C
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0833
Practice Address - Country:US
Practice Address - Phone:832-546-3216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION UNIVERSAL SOLUTIONS CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health