MEDICARE: RECOVERY LIFE MINISTRIES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1427439678
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY LIFE MINISTRIES

Provider Business Mailing Address
First Line	:	207 HUDSON TRCE
Second Line	:	SUITE 111
City	:	AUGUSTA
State	:	GA
Zip	:	30907-2010
Country	:	US
Telephone Number	:	706-799-7743
Fax Number	:	706-262-2899

Provider Business Practice Location Address
First Line	:	207 HUDSON TRCE
Second Line	:	SUITE 111
City	:	AUGUSTA
State	:	GA
Zip	:	30907-2010
Country	:	US
Telephone Number	:	706-799-7743
Fax Number	:	706-262-2899

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. BILLIE HULLUM
Credential	:
Telephone Number	:	706-799-7743

Provider Enumeration Date	:	06/13/2015
Last Update Date	:	06/13/2015

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Directions to “RECOVERY LIFE MINISTRIES ” Practice Location

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