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General NPI Number Information
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NPI Number | 1023373586
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Entity Type | Organization
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Legal Business Name | CLEVER RECOVERY
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 07/11/2012
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Provider Practice Location Address
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Address Line | 185 FOXTRAIL RD
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City | PICAYUNE
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State | MS
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Zip | 39466-9027
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Country | US
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Telephone | 601-215-2017
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Fax | 601-273-5018
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Provider Business Mailing Address
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Address Line | 185 FOXTRAIL RD
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City | PICAYUNE
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State | MS
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Zip | 39466-9027
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Country | US
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Telephone | 601-215-2017
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Fax | 601-273-5018
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. BECKY MAXIMO
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Credential |
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Telephone | 601-215-2017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 10662
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License Number State | MS
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