| Recovery Innovations, Inc | |
|
11361 N 99th Avenue Suites 400 & 402 Peoria AZ 85345 | |
| (602) 636-4605 | |
| (623) 972-6173 |
| Full Name | Recovery Innovations, Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 11361 N 99th Avenue, Peoria, Arizona |
| Authorized Official Name and Position | Corina Ogaz (ASSOCIATE DIRECTOR, CREDENTIALING) |
| Authorized Official Contact | 6026363085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Recovery Innovations, Inc 2701 N 16th Street Suite 316 Phoenix AZ 85006 Ph: (602) 650-1212 | Recovery Innovations, Inc 11361 N 99th Avenue Suites 400 & 402 Peoria AZ 85345 Ph: (602) 636-4605 |
| NPI Number | 1609243518 |
|---|---|
| Provider Enumeration Date | 08/26/2015 |
| Last Update Date | 06/21/2022 |
| Certification Date | 06/21/2022 |
| Medicare PECOS PAC ID | 1456500628 |
|---|---|
| Medicare Enrollment ID | O20170606002503 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609243518 | NPI | - | NPPES |
| 110785 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Arizona) | Secondary |
| 251S00000X | Community/behavioral Health | OTC7470 (Arizona) | Primary |
| Provider Name | Lisa A D'alessandro-betancourt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730251034 PECOS PAC ID: 3375606049 Enrollment ID: I20090107000517 |
| Provider Name | Tarry Wolfe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982655338 PECOS PAC ID: 1052459559 Enrollment ID: I20110606000748 |
| Provider Name | Kristen Lyn Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447545645 PECOS PAC ID: 8527237569 Enrollment ID: I20110809000606 |
| Provider Name | Renee H Kania |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184940652 PECOS PAC ID: 6204088123 Enrollment ID: I20121128000558 |
| Provider Name | Michael A Riddle |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1487859898 PECOS PAC ID: 3779646104 Enrollment ID: I20121228000386 |
| Provider Name | Anita T Sassaman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952644965 PECOS PAC ID: 1355589474 Enrollment ID: I20130601000027 |
| Provider Name | Amber Lynn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063842813 PECOS PAC ID: 3274762729 Enrollment ID: I20140204001341 |
| Provider Name | Kimberly Keene |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285004234 PECOS PAC ID: 2668781154 Enrollment ID: I20151023000975 |
| Provider Name | Allison Solarz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639727415 PECOS PAC ID: 9739513227 Enrollment ID: I20191216001178 |
| Provider Name | Destini Mayfield |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205467917 PECOS PAC ID: 5092146969 Enrollment ID: I20200508000444 |
| Provider Name | Charles Rodney Sharpe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134274194 PECOS PAC ID: 1951720515 Enrollment ID: I20200930003067 |
| Provider Name | Susannamma Lijan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003424102 PECOS PAC ID: 0244650745 Enrollment ID: I20201022001927 |
| Provider Name | Sherri Ann Rhodes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831796549 PECOS PAC ID: 7810309341 Enrollment ID: I20201207002346 |
| Provider Name | Crystal J Montague |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669887774 PECOS PAC ID: 1355560871 Enrollment ID: I20210426000260 |
| Provider Name | Kondal R Madaram |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1003952144 PECOS PAC ID: 4284826892 Enrollment ID: I20220309002809 |
| Provider Name | Jesika Louana Mckenzie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427634997 PECOS PAC ID: 2163816349 Enrollment ID: I20220404002157 |
| Provider Name | Jacquelyn Rene Bybee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447907019 PECOS PAC ID: 7719373448 Enrollment ID: I20220406001789 |
| Provider Name | Tamara Perryman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255688339 PECOS PAC ID: 5496773244 Enrollment ID: I20220926003300 |
| Provider Name | Jamie Wade |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225730997 PECOS PAC ID: 9234596305 Enrollment ID: I20230605002198 |
| Provider Name | Kingsley Eboru |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336916105 PECOS PAC ID: 6901257245 Enrollment ID: I20240110004529 |
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