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General NPI Number Information
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NPI Number | 1275363434
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Entity Type | Organization
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Legal Business Name | LADOGA RECOVERY CENTER, LLC
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Dates
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Enumeration Date | 08/02/2024
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 8506 S ACADEMY WAY
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City | LADOGA
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State | IN
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Zip | 47954-8112
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Country | US
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Telephone | 219-254-9951
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Fax |
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Provider Business Mailing Address
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Address Line | 15813 72ND AVE STE 2F
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City | FLUSHING
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State | NY
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Zip | 11365-4138
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | CHRISTOPHER FOSTER
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Credential |
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Telephone | 781-558-8696
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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