Organization
ROUND TABLE RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRA N NISHIKAWA (DIRECTOR)
(928) 533-2887
Entity
Organization
Contact information
Practice address
711 S GRANITE ST, SUITE B, PRESCOTT, AZ 86303-4241
(928) 533-2887
(928) 776-4781
Mailing address
711 S GRANITE ST, SUITE B, PRESCOTT, AZ 86303-4241
(928) 533-2887
(928) 776-4781
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
07/22/2011
Last updated
07/22/2011
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