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NPI Code Detail

MEDICARE: SANA LAKE RECOVERY CENTER, LLC

MEDICARE: SANA LAKE 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
1251S00000XCommunity/Behavioral Health Agency
2261QM0850XAdult Mental Health Clinic/Center
3324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1902430135
Entity Type Code : Organization
Provider Name (Legal Business Name) : SANA LAKE RECOVERY CENTER, LLC
Provider Business Mailing Address
First Line : 8350 HIGHWAY 30
Second Line :
City : DITTMER
State : MO
Zip : 63023-1909
Country : US
Telephone Number : 636-944-4436
Fax Number :
Provider Business Practice Location Address
First Line : 800 E 101ST TER STE 350
Second Line :
City : KANSAS CITY
State : MO
Zip : 64131-5310
Country : US
Telephone Number : 816-222-4347
Fax Number : 816-407-9597
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : MS. STACY GLENN
Credential : LCSW
Telephone Number : 314-392-3822
Provider Enumeration Date : 02/26/2020
Last Update Date : 03/31/2020

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Directions to “SANA LAKE RECOVERY CENTER, LLC ” Practice Location

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