Healthcare Provider Details

I. General information

NPI: 1174021406
Provider Name (Legal Business Name): ST. JOSEPH RECOVERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1824 MURDOCH AVE BLDG C
PARKERSBURG WV
26101-3230
US

IV. Provider business mailing address

1824 MURDOCH AVE BLDG C
PARKERSBURG WV
26101-3230
US

V. Phone/Fax

Practice location:
  • Phone: 304-916-1881
  • Fax:
Mailing address:
  • Phone: 304-916-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DONNA J MEADOWS
Title or Position: CEO
Credential:
Phone: 304-916-1881