Provider Demographics
NPI:1073220802
Name:STRUCTURE HOUSE RECOVERY LLC
Entity Type:Organization
Organization Name:STRUCTURE HOUSE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:PHILPOT
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-312-3912
Mailing Address - Street 1:403 WHITLEY ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2041
Mailing Address - Country:US
Mailing Address - Phone:606-312-3912
Mailing Address - Fax:
Practice Address - Street 1:1501 S MAIN ST UNIT G2
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-2091
Practice Address - Country:US
Practice Address - Phone:606-312-3912
Practice Address - Fax:606-260-8634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder