Healthcare Provider Details

I. General information

NPI: 1598386807
Provider Name (Legal Business Name): RIVERWALK RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7446 SHALLOWFORD RD STE 116
CHATTANOOGA TN
37421-2352
US

IV. Provider business mailing address

PO BOX 802
WEST PALM BEACH FL
33402-0802
US

V. Phone/Fax

Practice location:
  • Phone: 423-264-2600
  • Fax:
Mailing address:
  • Phone: 423-264-2600
  • Fax:

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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID FARACHE
Title or Position: CEO
Credential:
Phone: 423-264-2600