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General NPI Number Information
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NPI Number | 1316438773
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Entity Type | Organization
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Legal Business Name | ROAD TO RECOVERY, LLC
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Dates
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Enumeration Date | 05/22/2018
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Last Update Date | 08/14/2020
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Provider Practice Location Address
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Address Line | 111 COURT ST S
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City | RIPLEY
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State | WV
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Zip | 25271
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Country | US
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Telephone | 307-372-1030
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 190
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City | RIPLEY
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State | WV
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Zip | 25271-0190
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Country | US
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Telephone | 304-372-1030
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Fax |
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Authorized Official
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Title or Position | MANAGER/PARTNER
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Name | S CALES
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Credential |
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Telephone | 304-372-1030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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