Healthcare Provider Details

I. General information

NPI: 1851497143
Provider Name (Legal Business Name): DUAL RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 CLAY ST
LOUISVILLE KY
40203
US

IV. Provider business mailing address

1272 CLAY ST
LOUISVILLE KY
40203
US

V. Phone/Fax

Practice location:
  • Phone: 502-637-1000
  • Fax: 502-637-9111
Mailing address:
  • Phone: 502-637-1000
  • Fax: 502-637-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34004385A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1848
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN COWAN WARNER
Title or Position: OWNER
Credential: LCSW
Phone: 502-637-1000