Organization
SPARTAN RECOVERY LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA KIMBRO (DIRECTOR OF FINANCE)
(706) 633-3384
Entity
Organization
Contact information
Practice address
919 12TH PL STE 13, PRESCOTT, AZ 86305-1433
(833) 228-4222
(866) 697-2326
Mailing address
919 12TH PL STE 13, PRESCOTT, AZ 86305-1433
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
12/17/2019
Last updated
12/17/2019
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