Provider Demographics
NPI:1073142733
Name:TOTAL HEALTH AND RECOVERY CLINIC, LLC
Entity Type:Organization
Organization Name:TOTAL HEALTH AND RECOVERY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:304-771-9919
Mailing Address - Street 1:1824 MURDOCH AVE
Mailing Address - Street 2:F BUILDING, SUITE 201
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101
Mailing Address - Country:US
Mailing Address - Phone:304-588-9739
Mailing Address - Fax:888-522-7417
Practice Address - Street 1:1824 MURDOCH AVE BLDG F SUITE201
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-3230
Practice Address - Country:US
Practice Address - Phone:304-588-9739
Practice Address - Fax:888-522-7417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-05
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty