Provider Demographics
NPI:1609352186
Name:MOUNTAIN SPRINGS RECOVERY LLC
Entity type:Organization
Organization Name:MOUNTAIN SPRINGS RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANHOOSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-750-2014
Mailing Address - Street 1:DEPT# 880615 PO BOX 29650
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9650
Mailing Address - Country:US
Mailing Address - Phone:949-988-0471
Mailing Address - Fax:949-325-7818
Practice Address - Street 1:1865 WOODMOOR DR
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132
Practice Address - Country:US
Practice Address - Phone:949-988-0471
Practice Address - Fax:949-325-7818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-17
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility