Healthcare Provider Details

I. General information

NPI: 1750736021
Provider Name (Legal Business Name): RECOVERY CHAPEL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2016
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 W BENNETT ST
SPRINGFIELD MO
65807-1437
US

IV. Provider business mailing address

217 W BENNETT ST
SPRINGFIELD MO
65807
US

V. Phone/Fax

Practice location:
  • Phone: 417-887-7228
  • Fax: 417-763-3179
Mailing address:
  • Phone: 417-887-7228
  • Fax: 417-763-3179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: FARRIS ROBERTSON
Title or Position: DIRECTOR
Credential:
Phone: 417-207-0902