Healthcare Provider Details

I. General information

NPI: 1285107003
Provider Name (Legal Business Name): RECOVERY ASSOCIATES GROUP, AT SOUTHWIND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3257 W SARAZENS CIR
MEMPHIS TN
38125-0807
US

IV. Provider business mailing address

3257 W SARAZENS CIR
MEMPHIS TN
38125-0807
US

V. Phone/Fax

Practice location:
  • Phone: 901-590-4106
  • Fax: 901-343-0792
Mailing address:
  • Phone: 901-590-4106
  • Fax: 901-343-0792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SCHERRI N HENDERSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 901-618-4733