Healthcare Provider Details

I. General information

NPI: 1861089690
Provider Name (Legal Business Name): FIRST CITY RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2020
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W JEFFERSON ST
KOKOMO IN
46901-4437
US

IV. Provider business mailing address

317 W JEFFERSON ST
KOKOMO IN
46901-4437
US

V. Phone/Fax

Practice location:
  • Phone: 765-614-3580
  • Fax:
Mailing address:
  • Phone: 517-993-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: REESA MOSLEY
Title or Position: CFO
Credential:
Phone: 517-993-4416