Healthcare Provider Details

I. General information

NPI: 1740104058
Provider Name (Legal Business Name): SWEET SPRINGS LIFE RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 E HOSPITAL DR
SWEET SPRINGS MO
65351-2229
US

IV. Provider business mailing address

105 E HOSPITAL DR
SWEET SPRINGS MO
65351-2229
US

V. Phone/Fax

Practice location:
  • Phone: 660-200-9050
  • Fax: 660-600-3070
Mailing address:
  • Phone: 660-200-9050
  • Fax: 660-600-3070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: GENNADY KATSNELSON
Title or Position: OWNER
Credential:
Phone: 718-415-6167