Provider Demographics
NPI:1588223085
Name:THE RECOVERY CENTER, LLC
Entity Type:Organization
Organization Name:THE RECOVERY CENTER, LLC
Other - Org Name:COUNTY LINE PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:PEARL
Authorized Official - Last Name:NEACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-568-1184
Mailing Address - Street 1:41 JOHN MACO DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339-6515
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9221 KY 15 S
Practice Address - Street 2:
Practice Address - City:CAMPTON
Practice Address - State:KY
Practice Address - Zip Code:41301-9568
Practice Address - Country:US
Practice Address - Phone:606-568-1184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-08
Last Update Date:2019-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health