Organization
MILE HIGH DEVELOPERS LLC
Active
Other names
Phoenix House Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
JOYCE ANN FITZGERALD (OWNER)
(928) 899-8585
Entity
Organization
Contact information
Practice address
13651 N 32ND ST, PHOENIX, AZ 85032-6025
(928) 899-8585
Mailing address
4643 E KATHLEEN RD, PHOENIX, AZ 85032-4215
(602) 354-3692
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
092283
—
AZ
01
—
OTC11873
OUTPATIENT TREATMENT CENTER LICENSE AZDHS
AZ
Enumeration date
04/15/2021
Last updated
08/16/2022
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