Provider Demographics
NPI:1174399497
Name:ROCK RECOVERY
Entity type:Organization
Organization Name:ROCK RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:PROF
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:HOSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,
Authorized Official - Phone:623-734-7605
Mailing Address - Street 1:13223 W ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY WEST
Mailing Address - State:AZ
Mailing Address - Zip Code:85375-4510
Mailing Address - Country:US
Mailing Address - Phone:623-734-7605
Mailing Address - Fax:
Practice Address - Street 1:13223 W ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:SUN CITY WEST
Practice Address - State:AZ
Practice Address - Zip Code:85375-4510
Practice Address - Country:US
Practice Address - Phone:623-301-2404
Practice Address - Fax:623-462-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty