SPARTAN RECOVERY LIFE LLC
NPI 1114565553
Clinic/Center - Rehabilitation, Substance Use Disorder in Prescott, AZ

NPI Status: Active since December 17, 2019

Contact Information

919 12TH PL STE 13
PRESCOTT, AZ
ZIP 86305
Phone: (833) 228-4222
Fax: (866) 697-2326

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Group Taxonomy
Authorized Official
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Clinic/Center
Rehabilitation, Substance Use Disorder

About SPARTAN RECOVERY LIFE LLC

This page provides the complete NPI Profile along with additional information for Spartan Recovery Life Llc, a provider established in Prescott, Arizona operating as a Clinic/center, focusing in rehabilitation, substance use disorder . The healthcare provider is registered in the NPI registry with number 1114565553 assigned on December 2019. The practitioner's primary taxonomy code is 261QR0405X. The provider is registered as an organization and their NPI record was last updated 6 years ago. The organization operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Debra Kimbro (Director Of Finance)

NPI: 1114565553
Provider Name: SPARTAN RECOVERY LIFE LLC
Entity Type: Organization
Location Address: 919 12TH PL STE 13 PRESCOTT, AZ 86305
Location Phone: (833) 228-4222
Location Fax: (866) 697-2326
Mailing Address: 919 12TH PL STE 13 PRESCOTT, AZ 86305
Is Sole Proprietor?: No
Is Organization Subpart?: No
Enumeration Date: 12-17-2019
Last Update Date: 12-17-2019
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification: Clinic/Center Rehabilitation, Substance Use Disorder
Taxonomy Code: 261QR0405X
Type: Ambulatory Health Care Facilities

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No.	Taxonomy Code	Type	Classification / Specialization	License No. (State)
1	103TA0400X	Behavioral Health & Social Service Providers	Psychologist Addiction (Substance Use Disorder)

Group Taxonomy 193400000X SINGLE SPECIALTY GROUP

This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: DEBRA KIMBRO
Authorized Official Title: DIRECTOR OF FINANCE
Authorized Official Phone: (706) 633-3384

NPI Validation Check Digit Calculation

The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1	1	1	4	5	6	5	5	5	3
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2	1	2	4	10	6	10	5	10
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 1 + 2 + 4 + 1 + 0 + 6 + 1 + 0 + 5 + 1 + 0 + 24 = 47
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
50 - 47 = 3									3

The NPI number 1114565553 is valid because the calculated check digit 3 using the Luhn validation algorithm matches the last digit of the original NPI number.