Provider Demographics
NPI:1114524717
Name:OURRECOVERY2
Entity Type:Organization
Organization Name:OURRECOVERY2
Other - Org Name:OURRECOVERY2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TUESDAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FLORENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-509-0073
Mailing Address - Street 1:1312 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3609
Mailing Address - Country:US
Mailing Address - Phone:816-509-0073
Mailing Address - Fax:
Practice Address - Street 1:1312 HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3609
Practice Address - Country:US
Practice Address - Phone:816-509-0073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health