1386305753 NPI number — RECOVERY CARE OF COLUMBIA

Table of content: (NPI 1386305753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386305753 NPI number — RECOVERY CARE OF COLUMBIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERY CARE OF COLUMBIA
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:
1386305753
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6486 PEYTONSVILLE ARNO RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLLEGE GROVE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37046-9133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-775-3549
Provider Business Mailing Address Fax Number:
615-628-1428

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 CADILLAC DRIVE
Provider Second Line Business Practice Location Address:
SUITE 300, PMB 4
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37027-5337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-548-3062
Provider Business Practice Location Address Fax Number:
615-628-1428
Provider Enumeration Date:
01/06/2022

Additional Information

Authorized Official

Authorized Official Last Name:
STOLZER
Authorized Official First Name:
JON
Authorized Official Middle Name:
Authorized Official Title or Position:
CO-OWNER/MANAGING PARTNER
Authorized Official Telephone Number:
615-775-3549

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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