MEDICARE: SOLID 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1902619729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLID RECOVERY LLC

Provider Business Mailing Address
First Line	:	1320 NW HOMESTEAD DR STE G
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5243
Country	:	US
Telephone Number	:	405-353-2932
Fax Number	:

Provider Business Practice Location Address
First Line	:	1320 NW HOMESTEAD DR STE G
Second Line	:
City	:	LAWTON
State	:	OK
Zip	:	73505-5243
Country	:	US
Telephone Number	:	405-353-2932
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SEAN FARRELL
Credential	:
Telephone Number	:	580-507-2911

Provider Enumeration Date	:	01/27/2025
Last Update Date	:	12/01/2025

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