| Round Table Recovery, Llc | |
|
711 S Granite St Suite B Prescott AZ 86303-4241 | |
| (928) 533-2887 | |
| (928) 776-4781 |
| Full Name | Round Table Recovery, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 711 S Granite St, Prescott, Arizona |
| Authorized Official Name and Position | Ira N Nishikawa (DIRECTOR) |
| Authorized Official Contact | 9285332887 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Round Table Recovery, Llc 711 S Granite St Suite B Prescott AZ 86303-4241 Ph: (928) 533-2887 | Round Table Recovery, Llc 711 S Granite St Suite B Prescott AZ 86303-4241 Ph: (928) 533-2887 |
| NPI Number | 1316225444 |
|---|---|
| Provider Enumeration Date | 07/22/2011 |
| Last Update Date | 07/22/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316225444 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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