Healthcare Provider Details

I. General information

NPI: 1639429731
Provider Name (Legal Business Name): RECOVERY BEHAVIORAL HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2012
Last Update Date: 09/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 OLD SCIOTO TRL
PORTSMOUTH OH
45662-6642
US

IV. Provider business mailing address

PO BOX 1430
FRANKFORT KY
40602-1430
US

V. Phone/Fax

Practice location:
  • Phone: 859-236-7913
  • Fax:
Mailing address:
  • Phone: 502-226-3858
  • Fax: 502-223-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JAMIE DURHAM
Title or Position: MANAGING MEMBER
Credential: MANAGING MEMBER
Phone: 859-605-6390