Wolf Creek Recovery LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

WOLF CREEK RECOVERY LLC

Practice address

1470 W Gurley St
Prescott, AZ 86305-2855

Phone

(928) 379-4075

NPI assigned

Jul 20, 2021

Organization subpart

No

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

Authorized official

Name

Mr. Jonathon Phillip Ciampa

Title

Ceo

Phone

(928) 379-4075

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1626739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626739200000",
    "number": "1699348557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1470 W GURLEY ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863052855",
            "telephone_number": "928-379-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1470 W GURLEY ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863052855",
            "telephone_number": "928-379-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLF CREEK RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-20",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A",
        "authorized_official_last_name": "CIAMPA",
        "authorized_official_first_name": "JONATHON",
        "authorized_official_middle_name": "PHILLIP",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "928-379-4075",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHD. LCSW",
            "identifier": "1316013253",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "BestNotes",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1470 W Gurley St",
            "city": "Prescott",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "863052855",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Substance Abuse Rehabilitation Facility in Prescott, AZ
• Providers in Prescott, 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 Jul 20, 2021; 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.