Provider Demographics
NPI:1124546015
Name:DISCOVERY RIDGE RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:DISCOVERY RIDGE RECOVERY CENTER LLC
Other - Org Name:DISCOVERY RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MALLETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-331-9900
Mailing Address - Street 1:98 WESTCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTINTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-3901
Mailing Address - Country:US
Mailing Address - Phone:330-259-8813
Mailing Address - Fax:
Practice Address - Street 1:1824 MURDOCH AVE
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:330-259-8813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2345-0755OtherWEST VIRGINIA TAX DEPARTMENT