| Spartan Recovery Life LLC | |
|
919 12th Pl Ste 13 Prescott AZ 86305-1433 | |
| (833) 228-4222 | |
| (866) 697-2326 |
| Full Name | Spartan Recovery Life LLC |
|---|---|
| Speciality | Clinic/center - Rehabilitation, Substance Use Disorder |
| Location | 919 12th Pl Ste 13, Prescott, Arizona |
| Authorized Official Name and Position | Debra Kimbro (DIRECTOR OF FINANCE) |
| Authorized Official Contact | 7066333384 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Spartan Recovery Life LLC 919 12th Pl Ste 13 Prescott AZ 86305-1433 | Spartan Recovery Life LLC 919 12th Pl Ste 13 Prescott AZ 86305-1433 Ph: (833) 228-4222 |
| NPI Number | 1114565553 |
|---|---|
| Provider Enumeration Date | 12/17/2019 |
| Last Update Date | 12/17/2019 |
| Certification Date | 12/17/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114565553 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | () | Secondary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | () | Primary |
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