Healthcare Provider Details

I. General information

NPI: 1316438773
Provider Name (Legal Business Name): ROAD TO RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 COURT ST S
RIPLEY WV
25271
US

IV. Provider business mailing address

PO BOX 190
RIPLEY WV
25271-0190
US

V. Phone/Fax

Practice location:
  • Phone: 307-372-1030
  • Fax:
Mailing address:
  • Phone: 304-372-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: S CALES
Title or Position: MANAGER/PARTNER
Credential:
Phone: 304-372-1030