Healthcare Provider Details

I. General information

NPI: 1972257236
Provider Name (Legal Business Name): LANDMARK RECOVERY OF GREENFIELD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5017 S 110TH ST
GREENFIELD WI
53228-3131
US

IV. Provider business mailing address

720 COOL SPRINGS BLVD STE 500
FRANKLIN TN
37067-7259
US

V. Phone/Fax

Practice location:
  • Phone: 855-950-5035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ALICIA NEAL
Title or Position: CONTRACTING SPECIALIST
Credential:
Phone: 615-281-9050