Provider Demographics
NPI:1114664604
Name:FOUR RIVERS RECOVERY
Entity Type:Organization
Organization Name:FOUR RIVERS RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/ OPERATIONS AND OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:BECKY JO
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:154-123-9843
Mailing Address - Street 1:1019 SW 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2125
Mailing Address - Country:US
Mailing Address - Phone:541-239-8436
Mailing Address - Fax:
Practice Address - Street 1:1019 SW 3RD AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2125
Practice Address - Country:US
Practice Address - Phone:154-123-9843
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty