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General NPI Number Information
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NPI Number | 1922617133
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Entity Type | Organization
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Legal Business Name | RECOVERY CONCEPTS URBANA, LLC
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 710 W. KILLARNEY ST.
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City | URBANA
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State | IL
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Zip | 61801
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Country | US
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Telephone | 985-705-3263
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Fax |
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Provider Business Mailing Address
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Address Line | 12489 JOSEPHS RD
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City | FOLSOM
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State | LA
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Zip | 70437-5829
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Country | US
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Telephone | 985-705-3263
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. RICHARD MANKINEN
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Credential | MD
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Telephone | 708-335-1155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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