MEDICARE: RECOVERY MOBILE CLINIC

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	261Q00000X	Clinic/Center
2	363LA2100X	Acute Care Nurse Practitioner

General Provider Information

NPI Number	:	1902431653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RECOVERY MOBILE CLINIC

Provider Business Mailing Address
First Line	:	7111 DIXIE HWY # 142
Second Line	:
City	:	CLARKSTON
State	:	MI
Zip	:	48346-2077
Country	:	US
Telephone Number	:	248-563-5735
Fax Number	:

Provider Business Practice Location Address
First Line	:	4706 PRODUCT DR STE 1
Second Line	:
City	:	WIXOM
State	:	MI
Zip	:	48393-2071
Country	:	US
Telephone Number	:	248-567-2334
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MRS. JORDANA LEANNE LATOZAS
Credential	:	ACNP
Telephone Number	:	248-563-5735

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	12/03/2025

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Directions to “RECOVERY MOBILE CLINIC ” Practice Location

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