EMBARK RECOVERY LLC NPI 1184193963

NPI Information

NPI: 1184193963
Provider Name: EMBARK RECOVERY LLC
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 03D2159160

Address:
3727 KARICIO LN
PRESCOTT, AZ
ZIP 86303
Phone: (877) 215-2224
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EMBARK RECOVERY LLC is a rehabilitation and substance use disorder clinic center in Prescott, AZ. EMBARK RECOVERY LLC NPI is 1184193963. The provider is registered as an organization entity type.

The provider's business location address is:

3727 KARICIO LN
PRESCOTT, AZ
ZIP 86303-829
Phone: (877) 215-2224
Fax: (877) 215-2224

The provider's authorized official is David Slattery .
The authorized official title is Manager and has the following contact phone number (877) 215-2224.

The CLIA number assigned to this NPI record is 03D2159160 - comprehensive outpatient rehab with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/21/2018 and was last updated on 8/18/2021.

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	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	520332	MEDICAID	ARIZONA

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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