Provider Demographics
NPI:1043950322
Name:WHITE OWL RECOVERY
Entity Type:Organization
Organization Name:WHITE OWL RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT, CPMA, CPC
Authorized Official - Phone:859-229-4647
Mailing Address - Street 1:1024 GREENDALE RD UNIT 2103
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8320
Mailing Address - Country:US
Mailing Address - Phone:859-229-4647
Mailing Address - Fax:
Practice Address - Street 1:8699 S US HIGHWAY 25
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4973
Practice Address - Country:US
Practice Address - Phone:859-229-4647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty