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General NPI Number Information
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NPI Number | 1497427223
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Entity Type | Organization
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Legal Business Name | RECOVERY CONCEPTS III, LLC
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 09/30/2021
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Provider Practice Location Address
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Address Line | 5334 S ARCHER AVE STE A
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City | CHICAGO
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State | IL
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Zip | 60632-4970
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Country | US
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Telephone | 985-705-3263
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Fax | 346-616-1087
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Provider Business Mailing Address
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Address Line | 8055 WINNERS CIR
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City | MANDEVILLE
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State | LA
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Zip | 70448-7509
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Country | US
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Telephone | 985-705-3263
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Fax | 346-616-1087
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Authorized Official
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Title or Position | OPERATIONS DIRECTOR
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Name | MR. JOHN EGAN
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Credential | MPH
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Telephone | 985-705-3263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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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 | 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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