Organization
LIFE TRANSFORMATION RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID SANCHEZ (EXECUTIVE DIRECTOR)
(928) 515-0044
Entity
Organization
Contact information
Practice address
8521 E FLORENTINE RD STE B, PRESCOTT VALLEY, AZ 86314-8954
(928) 515-0044
(928) 433-4977
Mailing address
8521 E FLORENTINE RD STE B, PRESCOTT VALLEY, AZ 86314-8954
(928) 515-0044
(928) 433-4977
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
OTC7200
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
083523
—
AZ
Enumeration date
08/14/2015
Last updated
10/27/2016
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