Provider Demographics
NPI:1639808934
Name:CLINIC 5 ADDICTION RECOVERY
Entity Type:Organization
Organization Name:CLINIC 5 ADDICTION RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:THRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:256-312-2101
Mailing Address - Street 1:1 INDEPENDENT DR
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-3249
Mailing Address - Country:US
Mailing Address - Phone:256-312-2101
Mailing Address - Fax:256-952-2769
Practice Address - Street 1:1 INDEPENDENT DR
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-3249
Practice Address - Country:US
Practice Address - Phone:256-952-2709
Practice Address - Fax:256-952-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, ChildrenGroup - Single Specialty