Organization · NPI-2

Life Transformation Recovery

Clinic/Center, Mental Health (Including Community Mental Health Center) · Prescott Valley, AZ

NPI number1972979862
StatusActive
Last updated in NPPESOct 27, 2016

Details

NPI
1972979862
Entity type
Organization (NPI-2)
Legal business name
Life Transformation Recovery
Organization subpart
No
Enumeration date
Aug 14, 2015
Last updated
Oct 27, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)OTC7200AZYes

Practice location

8521 E Florentine Rd Ste B
Prescott Valley, AZ 86314-8954

Phone 928-515-0044 · Fax 928-433-4977

Mailing address

8521 E Florentine Rd Ste B
Prescott Valley, AZ 86314-8954

Phone 928-515-0044 · Fax 928-433-4977

Authorized official

David Sanchez
Executive Director
9285150044

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