Reboot Detox Az LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

IFBH8704 Issued in AZ

Legal business name

REBOOT DETOX AZ LLC

Practice address

1132 S Oakland
Mesa, AZ 85206-2682

Phone

(732) 903-1964

NPI assigned

Feb 22, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yeshaya Markovits

Title

Cfo

Phone

(718) 868-1600

Specialties & licenses 1

Addresses

Other names 1

• FOOTPRINTS TO RECOVERY Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1519257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519257600000",
    "number": "1417458753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1030",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087230090",
            "telephone_number": "732-903-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1132 S OAKLAND",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852062682",
            "telephone_number": "732-903-1964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBOOT DETOX AZ LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-22",
        "last_updated": "2018-02-22",
        "status": "A",
        "authorized_official_last_name": "MARKOVITS",
        "authorized_official_first_name": "YESHAYA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "718-868-1600"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "IFBH8704",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOOTPRINTS TO RECOVERY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Barbara Marie Reardon II
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• Lauren Terese Rebman, PMHNP-BC
• Marie Noelle M Recalde, FNP-C
• Reclaim Self Counseling, LLC
• Recon Dental Solutions LLC
• Recovery Empowerment Network, Inc.
• Recovery Help, LLC.

• Substance Abuse Rehabilitation Facility in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.