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General NPI Number Information
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NPI Number | 1760928212
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Entity Type | Organization
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Legal Business Name | LIVING HOPE RECOVERY CENTER
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 1531 SW COMMERCIAL GLN
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City | LAKE CITY
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State | FL
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Zip | 32025-0454
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Country | US
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Telephone | 386-365-4635
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Fax |
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Provider Business Mailing Address
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Address Line | 1531 SW COMMERCIAL GLN
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City | LAKE CITY
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State | FL
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Zip | 32025-0454
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Country | US
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Telephone | 386-365-4635
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Fax |
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Authorized Official
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Title or Position | ONBOARDING MANAGER
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Name | KELI KORNMILLER
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Credential |
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Telephone | 561-672-8345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0800X
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Taxonomy Name | Recovery Care Clinic/Center
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License Number |
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License Number State |
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