Healthcare Provider Details

I. General information

NPI: 1578279089
Provider Name (Legal Business Name): THE RECOVERY CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 CONNELL PARK LN STE A
BATON ROUGE LA
70806-6534
US

IV. Provider business mailing address

PO BOX 3327
SLIDELL LA
70459-3327
US

V. Phone/Fax

Practice location:
  • Phone: 985-781-0548
  • Fax: 985-781-4319
Mailing address:
  • Phone: 985-781-0548
  • Fax: 985-781-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TODD BOSSIER
Title or Position: MANAGER
Credential: FNP
Phone: 225-773-3379