Healthcare Provider Details

I. General information

NPI: 1639808934
Provider Name (Legal Business Name): CLINIC 5 ADDICTION RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 INDEPENDENT DR
RAINBOW CITY AL
35906-3249
US

IV. Provider business mailing address

1 INDEPENDENT DR
RAINBOW CITY AL
35906-3249
US

V. Phone/Fax

Practice location:
  • Phone: 256-952-2709
  • Fax: 256-952-2769
Mailing address:
  • Phone: 256-312-2101
  • Fax: 256-952-2769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER THRASHER
Title or Position: CEO
Credential: OWNER
Phone: 256-312-2101