Healthcare Provider Details

I. General information

NPI: 1366150799
Provider Name (Legal Business Name): KINGDOM RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2022
Last Update Date: 09/01/2023
Certification Date: 09/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W 3RD NORTH ST
MORRISTOWN TN
37814-3896
US

IV. Provider business mailing address

850 W 3RD NORTH ST
MORRISTOWN TN
37814-3896
US

V. Phone/Fax

Practice location:
  • Phone: 423-200-4991
  • Fax:
Mailing address:
  • Phone: 423-200-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JAMES HOWE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 423-200-4991