Provider Demographics
NPI:1346947025
Name:ST. JOSEPH RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:ST. JOSEPH RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEADOWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-916-1881
Mailing Address - Street 1:1824 MURDOCH AVE BLDG C
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26101-3230
Mailing Address - Country:US
Mailing Address - Phone:304-916-1881
Mailing Address - Fax:304-974-0433
Practice Address - Street 1:1073 ARBUCKLE RD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1745
Practice Address - Country:US
Practice Address - Phone:304-254-6159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST JOSEPH RECOVERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1174021406Medicaid