MEDICARE: FOUNDATION FOR RECOVERY, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist
3	171M00000X	Case Manager/Care Coordinator
4	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1144108994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOUNDATION FOR RECOVERY, INC.

Provider Business Mailing Address
First Line	:	4800 ALPINE PL STE 12
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-4086
Country	:	US
Telephone Number	:	702-257-8199
Fax Number	:	702-257-8299

Provider Business Practice Location Address
First Line	:	4800 ALPINE PL STE 12
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-4086
Country	:	US
Telephone Number	:	702-257-8199
Fax Number	:	702-257-8299

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SEAN HENRY O'DONNELL
Credential	:	CPRS
Telephone Number	:	702-461-9649

Provider Enumeration Date	:	08/21/2025
Last Update Date	:	09/07/2025

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