1194979948 NPI number — RECOVERCARE, LLC

Table of content: (NPI 1194979948)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194979948 NPI number — RECOVERCARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERCARE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194979948
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 STANLEY GAULT PARKWAY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40223-4209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-489-9449
Provider Business Mailing Address Fax Number:
502-657-3126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2750 S. 18TH PLACE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85034-4045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-426-9788
Provider Business Practice Location Address Fax Number:
602-426-9791
Provider Enumeration Date:
11/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ZAPPONE
Authorized Official First Name:
MARY
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
502-489-9449

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  07681270G , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 645697 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2385986 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 631401500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2005657 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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