=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649967795
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RECOVERY SOLDIERS MINISTRIES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2023
-----------------------------------------------------
Last Update Date | 05/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1180 BRISTOL HWY
-----------------------------------------------------
City | ELIZABETHTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37643-6684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-747-3803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1180 BRISTOL HWY
-----------------------------------------------------
City | ELIZABETHTON
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37643-6684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-747-3803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | LINCOLN SHELTON
-----------------------------------------------------
Credential | LPC,MHSP
-----------------------------------------------------
Telephone | 423-747-3803
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------