MEDICARE: 217 RECOVERY

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	347E00000X	Transportation Broker

General Provider Information

NPI Number	:	1679197503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	217 RECOVERY

Provider Business Mailing Address
First Line	:	2928 GLEN DR APT 5
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-4626
Country	:	US
Telephone Number	:	269-944-9559
Fax Number	:

Provider Business Practice Location Address
First Line	:	2928 GLEN DR APT 5
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-4626
Country	:	US
Telephone Number	:	269-944-9559
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. COREY WINFIELD
Credential	:
Telephone Number	:	269-944-9559

Provider Enumeration Date	:	06/06/2020
Last Update Date	:	06/06/2020

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