Organization
PARAMOUNT RECOVERY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIQUE CLARK (BILLING)
(928) 460-0593
Entity
Organization
Contact information
Practice address
602 BONITA WAY, PRESCOTT, AZ 86301-1002
(928) 583-3409
Mailing address
PO BOX 4353, PRESCOTT, AZ 86302-4353
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
BL04112
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BL04112
STATE LICENSE
AZ
Enumeration date
11/28/2017
Last updated
11/28/2017
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