Healthcare Provider Details

I. General information

NPI: 1508392697
Provider Name (Legal Business Name): CALYX RECOVERY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 HIOAKS RD
RICHMOND VA
23225-4043
US

IV. Provider business mailing address

681 HIOAKS RD
RICHMOND VA
23225-4043
US

V. Phone/Fax

Practice location:
  • Phone: 504-722-9996
  • Fax:
Mailing address:
  • Phone: 504-722-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEB BIRD
Title or Position: CEO
Credential: MS, LAC
Phone: 610-334-5216