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NPI Code Detail

MEDICARE: MANIFEST RECOVERY

MEDICARE: MANIFEST 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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1952899775
Entity Type Code : Organization
Provider Name (Legal Business Name) : MANIFEST RECOVERY
Provider Business Mailing Address
First Line : 1301 SHILOH RD NW STE 1840
Second Line :
City : KENNESAW
State : GA
Zip : 30144-7171
Country : US
Telephone Number : 877-752-5262
Fax Number :
Provider Business Practice Location Address
First Line : 1215 HIGHTOWER TRL STE 201
Second Line :
City : SANDY SPRINGS
State : GA
Zip : 30350-6244
Country : US
Telephone Number : 877-752-5262
Fax Number :
Authorized Official
Title or Position : CEO
Name : VICTOR ALFONSO
Credential :
Telephone Number : 818-212-4659
Provider Enumeration Date : 04/26/2018
Last Update Date : 04/26/2018

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Directions to “MANIFEST RECOVERY ” Practice Location

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