Hard Rock Recovery Center LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

HARD ROCK RECOVERY CENTER LLC

Practice address

1616 E Indian School Road Suite 415
Phoenix, AZ 85016

Phone

(207) 415-5393

NPI assigned

May 8, 2023

Organization subpart

No

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

Authorized official

Name

Michel Kanyambo

Title

Chief Executive Officer

Phone

(207) 415-5393

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1683504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683504000000",
    "number": "1609565340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1616 E INDIAN SCHOOL ROAD 415",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85016",
            "telephone_number": "207-415-5393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1616 E INDIAN SCHOOL ROAD SUITE 415",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85016",
            "telephone_number": "207-415-5393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARD ROCK RECOVERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-08",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-07",
        "status": "A",
        "authorized_official_last_name": "KANYAMBO",
        "authorized_official_first_name": "MICHEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "207-415-5393"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harbor Health
• Harbor Health Integrated Care Clinic
• Harbor Health Integrated Care Clinic
• Harbor Health Integrated Care LLC
• Jeanette Renee Harbour, RN
• Tiffany Etheredge Hardaway, M.D.
• Brandy N Harden, LCSW
• Chelsea Harden, CTRS
• Tracy Christine Harder, LPC
• Aubrey Hardesty, PSYD

• Community/Behavioral Health Agency in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Community/Behavioral Health Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; 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.