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NPI Code Detail

MEDICARE: ST. JOSEPH RECOVERY CENTER, LLC

MEDICARE: ST. JOSEPH 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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2251S00000XCommunity/Behavioral Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346947025
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. JOSEPH RECOVERY CENTER, LLC
Provider Business Mailing Address
First Line : 1824 MURDOCH AVE BLDG C
Second Line :
City : PARKERSBURG
State : WV
Zip : 26101-3230
Country : US
Telephone Number : 304-916-1881
Fax Number : 304-974-0433
Provider Business Practice Location Address
First Line : 1073 ARBUCKLE RD
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-1745
Country : US
Telephone Number : 304-254-6159
Fax Number :
Authorized Official
Title or Position : CEO
Name : DONNA J MEADOWS
Credential :
Telephone Number : 304-916-1881
Provider Enumeration Date : 02/13/2023
Last Update Date : 02/13/2023

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