Healthcare Provider Details

I. General information

NPI: 1205447059
Provider Name (Legal Business Name): RECONNECTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 03/03/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 8TH AVE SUITE 2
HUNTINGTON WV
25703-1702
US

IV. Provider business mailing address

PO BOX 1603
HUNTINGTON WV
25717-1603
US

V. Phone/Fax

Practice location:
  • Phone: 304-962-2087
  • Fax: 304-523-9084
Mailing address:
  • Phone: 304-962-2087
  • Fax: 304-523-9084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. AARON RASHID JONES
Title or Position: PARTNER
Credential:
Phone: 304-751-6258