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General NPI Number Information
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NPI Number | 1679168421
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Entity Type | Organization
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Legal Business Name | MOSHEIM RECOVERY ASSOCIATES INC
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 65 PAYNE RD
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City | MOSHEIM
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State | TN
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Zip | 37818-3206
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Country | US
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Telephone | 423-422-2126
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Fax |
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Provider Business Mailing Address
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Address Line | 2740 LEVINE RD
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City | ODENVILLE
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State | AL
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Zip | 35120-6616
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Country | US
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Telephone | 205-246-5690
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MELISSA COX
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Credential |
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Telephone | 205-246-5690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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