Provider Demographics
NPI:1689332470
Name:RECOVERY4LIFE
Entity Type:Organization
Organization Name:RECOVERY4LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:CLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S, LICDC, MBA
Authorized Official - Phone:614-352-6807
Mailing Address - Street 1:124 HYATTS RD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-8961
Mailing Address - Country:US
Mailing Address - Phone:614-352-6807
Mailing Address - Fax:
Practice Address - Street 1:124 HYATTS RD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-8961
Practice Address - Country:US
Practice Address - Phone:614-352-6807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)