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General NPI Number Information
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NPI Number | 1538869144
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Entity Type | Organization
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Legal Business Name | RECOVERY RANCH, LLC
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 47 PR DR 3838
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City | CHESAPEAKE
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State | OH
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Zip | 45619
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Country | US
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Telephone | 740-861-0238
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Fax |
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Provider Business Mailing Address
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Address Line | 47 PR DR 3838
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City | CHESAPEAKE
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State | OH
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Zip | 45619
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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 | COMPLIANCE
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Name | BILLY CONNOLLY
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Credential |
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Telephone | 928-273-1997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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