Provider Demographics
NPI:1689912636
Name:ADDO RECOVERY
Entity Type:Organization
Organization Name:ADDO RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:CHRISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-369-6807
Mailing Address - Street 1:199 N 290 W
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LINDON
Mailing Address - State:UT
Mailing Address - Zip Code:84042-1810
Mailing Address - Country:US
Mailing Address - Phone:801-369-6807
Mailing Address - Fax:
Practice Address - Street 1:199 N 290 W
Practice Address - Street 2:SUITE 150
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1810
Practice Address - Country:US
Practice Address - Phone:801-369-6807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT501416-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty