Organization
PARTNERS IN RECOVERY, LLC
Active
Other names
ACT West Valley IHH
Organization subpart
No
Provider details
NPI number
Authorized official
LATRICE SHANNON HICKMAN (CHIEF RISK AND COMPLIANCE OFFICER)
(480) 431-9008
Entity
Organization
Contact information
Practice address
14100 NORTH 83RD AVENUE, SUITES 100 AND 150, PEORIA, AZ 85381
(623) 583-0232
(623) 583-1830
Mailing address
924 N COUNTRY CLUB DR, MESA, AZ 85201-4108
(480) 969-3800
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTC8768
ARIZONA DEPARTMENT OF HEALT SERVICES LICENSE
AZ
Enumeration date
04/02/2024
Last updated
04/02/2024
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