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General NPI Number Information
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NPI Number | 1225884216
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Entity Type | Organization
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Legal Business Name | CARBONATE RECOVERY CENTER, INC
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Dates
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Enumeration Date | 04/29/2024
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 101 EMPTY SADDLE TRL STE 120
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City | HAILEY
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State | ID
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Zip | 83333-8437
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Country | US
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Telephone | 208-928-7507
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Fax |
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Provider Business Mailing Address
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Address Line | 101 EMPTY SADDLE TRL STE 120
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City | HAILEY
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State | ID
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Zip | 83333-8437
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Country | US
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Telephone | 208-928-7507
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | KIMBERLY HAYES
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Credential | LCSW
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Telephone | 208-720-2049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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