MEDICARE: RECOVERY NETWORK, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	2569	WI
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	2569	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427367085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY NETWORK, INC

Provider Business Mailing Address
First Line	:	1314 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2114
Country	:	US
Telephone Number	:	414-647-9930
Fax Number	:	414-647-9931

Provider Business Practice Location Address
First Line	:	1314 W NATIONAL AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53204-2114
Country	:	US
Telephone Number	:	414-647-9930
Fax Number	:	414-647-9931

Authorized Official
Title or Position	:	PRESIDENT-RECOVERY NETWORK, INC
Name	:	MR. JAMES W VALONA II
Credential	:
Telephone Number	:	414-403-0232

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	09/30/2010

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