MEDICARE: DENOVO RECOVERY, 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	324500000X	Substance Abuse Rehabilitation Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NA	OTHER		NA

General Provider Information

NPI Number	:	1356923122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENOVO RECOVERY, LLC

Provider Business Mailing Address
First Line	:	2102 VILLAGE DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-4983
Country	:	US
Telephone Number	:	816-689-0691
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 VILLAGE DR
Second Line	:
City	:	SAINT JOSEPH
State	:	MO
Zip	:	64506-4983
Country	:	US
Telephone Number	:	816-244-8587
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ABIGAIL BARNES
Credential	:
Telephone Number	:	210-789-6121

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	08/04/2021

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Directions to “DENOVO RECOVERY, LLC ” Practice Location

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