Healthcare Provider Details

I. General information

NPI: 1558945220
Provider Name (Legal Business Name): ASSURANCE HEALTH & RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 YUMA RD
LOGAN WV
25601-7111
US

IV. Provider business mailing address

50 YUMA RD
LOGAN WV
25601-7111
US

V. Phone/Fax

Practice location:
  • Phone: 304-688-9860
  • Fax: 304-688-9862
Mailing address:
  • Phone: 304-688-9860
  • Fax: 304-688-9862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA MCCARTY
Title or Position: OWNER/ADMINISTRATOR
Credential: MS, MBA, MHA
Phone: 304-615-9925