Provider Demographics
NPI:1437323870
Name:RECOVERY NETWORK, INC.
Entity Type:Organization
Organization Name:RECOVERY NETWORK, INC.
Other - Org Name:RECOVERY NETWORK -TRANSITIONAL LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT-RECOVERY NETWORK, INC.
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:VALONA
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:414-403-0232
Mailing Address - Street 1:825 S 14TH ST
Mailing Address - Street 2:1314 WEST NATIONAL AVE.
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-2163
Mailing Address - Country:US
Mailing Address - Phone:414-647-9930
Mailing Address - Fax:414-647-9931
Practice Address - Street 1:1314 W. NATIONAL AVENUE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2163
Practice Address - Country:US
Practice Address - Phone:414-727-7985
Practice Address - Fax:414-727-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2569251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39179200Medicaid
WI42239500Medicaid
WI42239521Medicaid