SPARTAN RECOVERY LIFE LLC NPI 1114565553

NPI Information

NPI: 1114565553
Provider Name: SPARTAN RECOVERY LIFE LLC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

Address:
919 12TH PL STE 13
PRESCOTT, AZ
ZIP 86305
Phone: (833) 228-4222
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SPARTAN RECOVERY LIFE LLC is a rehabilitation and substance use disorder clinic center in Prescott, AZ. SPARTAN RECOVERY LIFE LLC NPI is 1114565553. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

919 12TH PL STE 13
PRESCOTT, AZ
ZIP 86305-433
Phone: (833) 228-4222
Fax: (866) 697-2326

The provider's authorized official is Debra Kimbro .
The authorized official title is Director Of Finance and has the following contact phone number (706) 633-3384.

The enumeration date for this NPI number is 12/17/2019 and was last updated on 12/17/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	103TA0400X	Psychologist	Addiction (Substance Use Disorder)			No
2	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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