Provider Demographics
NPI:1235779265
Name:IN HOME RECOVERY CARE
Entity Type:Organization
Organization Name:IN HOME RECOVERY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOUNLACKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-377-5623
Mailing Address - Street 1:4300 BAYOU BLVD STE 35B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2671
Mailing Address - Country:US
Mailing Address - Phone:850-377-5623
Mailing Address - Fax:
Practice Address - Street 1:4300 BAYOU BLVD STE 35B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2671
Practice Address - Country:US
Practice Address - Phone:850-377-5623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL19000221536Medicaid