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General NPI Number Information
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NPI Number | 1255409447
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Entity Type | Organization
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Legal Business Name | SELF-RECOVERY, LLC
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 106 N LANIER AVE
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City | LANETT
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State | AL
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Zip | 36863-2014
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Country | US
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Telephone | 334-644-6848
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Fax | 334-644-5443
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Provider Business Mailing Address
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Address Line | 106 N LANIER AVE
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City | LANETT
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State | AL
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Zip | 36863-2014
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Country | US
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Telephone | 334-644-6848
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Fax | 334-644-5543
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Authorized Official
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Title or Position | OWNER
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Name | TOMMY MOORE
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Credential | CEO
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Telephone | 334-644-6848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 00022660
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License Number State | AL
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