Provider Demographics
NPI:1538518931
Name:MARIETTA RECOVERY CENTERS, INC
Entity Type:Organization
Organization Name:MARIETTA RECOVERY CENTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-800-8387
Mailing Address - Street 1:1290 KENNESTONE CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-6009
Mailing Address - Country:US
Mailing Address - Phone:404-237-5519
Mailing Address - Fax:404-262-2557
Practice Address - Street 1:70 GRUBER LN
Practice Address - Street 2:SUITE 107
Practice Address - City:ST SIMONS ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31522-2881
Practice Address - Country:US
Practice Address - Phone:404-237-5519
Practice Address - Fax:404-262-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder