1659122844 NPI number — REBUILT TREATMENT AND RECOVERY LLC

Table of content: DR. FREDDIE JAMES BENNETT MD (NPI 1851353155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659122844 NPI number — REBUILT TREATMENT AND RECOVERY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REBUILT TREATMENT AND RECOVERY 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:
1659122844
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1220 N HOWARD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99201-2410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-505-4415
Provider Business Mailing Address Fax Number:
509-621-2011

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1220 N HOWARD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-505-4415
Provider Business Practice Location Address Fax Number:
509-621-2011
Provider Enumeration Date:
03/27/2024

Additional Information

Authorized Official

Authorized Official Last Name:
NONE
Authorized Official First Name:
NONE
Authorized Official Middle Name:
Authorized Official Title or Position:
NONE
Authorized Official Telephone Number:
509-505-4415

Provider Taxonomy Codes

  • Taxonomy code: 324500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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