Provider Demographics
NPI:1437685799
Name:ROAD TO RECOVERY, INC.
Entity Type:Organization
Organization Name:ROAD TO RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:MS LCPC
Authorized Official - Phone:208-233-9135
Mailing Address - Street 1:PO BOX 6249
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-6249
Mailing Address - Country:US
Mailing Address - Phone:208-233-9135
Mailing Address - Fax:208-233-9136
Practice Address - Street 1:165 W. MAIN
Practice Address - Street 2:
Practice Address - City:LAVA HOT SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83246
Practice Address - Country:US
Practice Address - Phone:208-233-9135
Practice Address - Fax:208-233-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID000133235324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility