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General NPI Number Information
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NPI Number | 1669168837
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Entity Type | Organization
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Legal Business Name | REC LIFE LLC
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Dates
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Enumeration Date | 04/12/2023
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Last Update Date | 04/12/2023
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Provider Practice Location Address
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Address Line | 4870 SADLER ROAD STE 300 #5050
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City | GLEN ALLEN
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State | VA
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Zip | 23060
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Country | US
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Telephone | 804-762-0063
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Fax |
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Provider Business Mailing Address
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Address Line | 4870 SADLER ROAD STE 300 #5050
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City | GLEN ALLEN
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State | VA
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Zip | 23060
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Country | US
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Telephone | 804-762-0063
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DEANNA GREENE
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Credential | M.S.,CTRS,CCLS,QMHP
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Telephone | 804-762-0063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State |
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