Organization
ILLUMINATE RECOVERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE FERNANDEZ (CHIEF OPERATING OFFICER)
(480) 262-1239
Entity
Organization
Contact information
Practice address
10619 N HAYDEN RD STE A-108, SCOTTSDALE, AZ 85260-8529
(480) 262-1239
Mailing address
10619 N HAYDEN RD STE A-108, SCOTTSDALE, AZ 85260-8529
(480) 262-1239
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
04/21/2020
Last updated
04/21/2020
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