MEDICARE: RECOVERY FOUNDATIONS 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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1023618071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY FOUNDATIONS LLC

Provider Business Mailing Address
First Line	:	2101 TWIN AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-1359
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1856 STONY POINT RD
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-9601
Country	:	US
Telephone Number	:	704-802-4145
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/OWNER
Name	:	DIANNE HUITT
Credential	:	QP, CADC, NCCPSS,
Telephone Number	:	704-777-4335

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	10/29/2020

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