1245772482 NPI number — FOUNTAIN HILLS RECOVERY, LLC

Table of content: MR. MARLIN JONES SR. LCSW (NPI 1811730146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245772482 NPI number — FOUNTAIN HILLS RECOVERY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUNTAIN HILLS RECOVERY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245772482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16872 E AVENUE OF THE FOUNTAINS
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
FOUNTAIN HILLS
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85268-8312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-715-2004
Provider Business Mailing Address Fax Number:
480-476-8901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16872 E AVENUE OF THE FOUNTAINS
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
FOUNTAIN HILLS
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85268-8312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-715-2004
Provider Business Practice Location Address Fax Number:
480-476-8901
Provider Enumeration Date:
11/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SALEM
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
800-715-2004

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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