Provider Demographics
NPI:1487841045
Name:RECOVERY HEALTH SERVICES
Entity Type:Organization
Organization Name:RECOVERY HEALTH SERVICES
Other - Org Name:BYRON HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MAROTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-637-3166
Mailing Address - Street 1:12101 LIMA RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-8903
Mailing Address - Country:US
Mailing Address - Phone:260-637-3166
Mailing Address - Fax:260-637-3536
Practice Address - Street 1:12101 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-8903
Practice Address - Country:US
Practice Address - Phone:260-637-3166
Practice Address - Fax:260-637-3536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN665110Medicare PIN