1437323870 NPI number — RECOVERY NETWORK, INC.

Table of content: (NPI 1437323870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437323870 NPI number — RECOVERY NETWORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RECOVERY NETWORK, INC.
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:
6
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:
1437323870
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 S 14TH ST
Provider Second Line Business Mailing Address:
1314 WEST NATIONAL AVE.
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53204-2163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-647-9930
Provider Business Mailing Address Fax Number:
414-647-9931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1314 W. NATIONAL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53204-2163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-727-7985
Provider Business Practice Location Address Fax Number:
414-727-8121
Provider Enumeration Date:
04/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VALONA
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT-RECOVERY NETWORK, INC.
Authorized Official Telephone Number:
414-403-0232

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2569 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 39179200 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42239500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 42239521 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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