Healthcare Provider Details

I. General information

NPI: 1205004298
Provider Name (Legal Business Name): RECOVERY TECHNOLOGY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N WEST AVE SUITE 400
JACKSON MI
49202-2179
US

IV. Provider business mailing address

1200 N WEST AVE SUITE 400
JACKSON MI
49202-2179
US

V. Phone/Fax

Practice location:
  • Phone: 517-780-3336
  • Fax: 517-796-4561
Mailing address:
  • Phone: 517-780-3336
  • Fax: 517-796-4561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: GREGORY F GALLAGHER
Title or Position: CEO
Credential: LMSW
Phone: 517-780-3336