Healthcare Provider Details

I. General information

NPI: 1033029376
Provider Name (Legal Business Name): IOWA CITY RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 W HWY 1
IOWA CITY IA
52240
US

IV. Provider business mailing address

301 S LIVINGSTON ST STE 200
MADISON WI
53703-5401
US

V. Phone/Fax

Practice location:
  • Phone: 608-438-3131
  • Fax:
Mailing address:
  • Phone: 608-438-3131
  • Fax: 608-284-7426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACK MCKENZIE
Title or Position: OWNER
Credential:
Phone: 608-438-3131