Healthcare Provider Details

I. General information

NPI: 1609203447
Provider Name (Legal Business Name): RECOVERY OF LOUISA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MEDICAL HTS
LOUISA KY
41230-9603
US

IV. Provider business mailing address

1192 N HIGHWAY 3
LOUISA KY
41230-6439
US

V. Phone/Fax

Practice location:
  • Phone: 606-615-0081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMMIE KLEIN
Title or Position: OWNER
Credential:
Phone: 606-615-0081