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General NPI Number Information
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NPI Number | 1104286475
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Entity Type | Organization
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Legal Business Name | THE RECOVERY COUNCIL
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 218 E NORTH ST
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City | WAVERLY
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State | OH
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Zip | 45690-1148
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Country | US
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Telephone | 740-370-2126
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Fax |
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Provider Business Mailing Address
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Address Line | 2734 BRUCE DR
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City | ASHLAND
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State | KY
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Zip | 41102-5503
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Country | US
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Telephone | 740-370-2126
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE
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Name | MR. TOM JOHNSON
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Credential | M.ED
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Telephone | 740-370-2126
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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 | S0700086
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License Number State | OH
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