Healthcare Provider Details

I. General information

NPI: 1770465650
Provider Name (Legal Business Name): AHBACON RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6882 DERBY RUN DR
WHITSETT NC
27377-9825
US

IV. Provider business mailing address

6882 DERBY RUN DR
WHITSETT NC
27377-9825
US

V. Phone/Fax

Practice location:
  • Phone: 828-280-0349
  • Fax: 828-280-0349
Mailing address:
  • Phone: 828-280-0349
  • Fax: 828-280-0349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANITA BACON
Title or Position: OWNER
Credential:
Phone: 828-280-0349