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Organization

NORTHSIGHT RECOVERY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JEREMY BLOOM (MEMBER/CEO)
(480) 544-0283
Entity
Organization

Contact information

Practice address
1440 E SOUTHERN AVE, TEMPE, AZ 85282-5612
(480) 544-0283
Mailing address
10441 E THATCHER AVE, MESA, AZ 85212-8338
(480) 544-0283

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
251S00000X
Community/Behavioral Health Agency
261QH0100X
Health Service Clinic/Center
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
261QM0850X
Adult Mental Health Clinic/Center
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
291U00000X
Clinical Medical Laboratory
343900000X
Non-emergency Medical Transport (VAN)

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
03D2245576
CLIA
AZ
05
109815
AZ
01
687990
JOINT COMISSION
AZ
01
OTC11514
FACILITY STATE LICENSE
AZ
Enumeration date
12/08/2021
Last updated
04/20/2023
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