Organization
NORTHSIGHT RECOVERY LLC
Active
Other names
Northsight Recovery- Mesa
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY VINCENT BLOOM (PRESIDENT/CEO)
(480) 544-0283
Entity
Organization
Contact information
Practice address
605 N GILBERT RD, MESA, AZ 85203-6629
(480) 544-0283
Mailing address
1440 E SOUTHERN AVE, TEMPE, AZ 85282-5612
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
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
—
03D2289209
CLIA
—
05
—
185032
—
AZ
01
—
OTC13229
DEPARTMENT OF HEALTH LICENSE
AZ
Enumeration date
01/15/2024
Last updated
07/29/2024
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