Healthcare Provider Details

I. General information

NPI: 1225913643
Provider Name (Legal Business Name): CLEAR HORIZONS RECOVERY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HOSPITAL DR
WETUMPKA AL
36092-1625
US

IV. Provider business mailing address

2320 N ANN ST
ECLECTIC AL
36024-5776
US

V. Phone/Fax

Practice location:
  • Phone: 334-567-4311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JADE LANE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 334-567-4311