MEDICARE: TRANSITIONS RECOVERY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM2800X	Methadone Clinic

General Provider Information

NPI Number	:	1023506656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRANSITIONS RECOVERY CENTER, LLC

Provider Business Mailing Address
First Line	:	4709 WENDOVER BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2530
Country	:	US
Telephone Number	:	318-623-5839
Fax Number	:

Provider Business Practice Location Address
First Line	:	4709 WENDOVER BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2530
Country	:	US
Telephone Number	:	318-623-5839
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KNAKITA BAILEY
Credential	:
Telephone Number	:	318-623-5839

Provider Enumeration Date	:	04/30/2018
Last Update Date	:	04/30/2018

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