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General NPI Number Information
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NPI Number | 1730034992
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Entity Type | Organization
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Legal Business Name | RIVERCREST RECOVERY LLC
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Dates
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Enumeration Date | 03/03/2026
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Last Update Date | 03/03/2026
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Provider Practice Location Address
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Address Line | 910 US HIGHWAY 321 NW
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City | HICKORY
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State | NC
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Zip | 28601-4700
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Country | US
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Telephone | 202-558-8223
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Fax |
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Provider Business Mailing Address
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Address Line | 4200 EVEREST DR
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City | GASTONIA
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State | NC
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Zip | 28054-0004
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Country | US
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Telephone | 202-558-8223
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JORDAN RASHAD TYLER
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Credential |
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Telephone | 202-558-8223
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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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