Provider Demographics
NPI:1700030525
Name:RECOVERY SERVICES OF DEKALB COUNTY, INC
Entity Type:Organization
Organization Name:RECOVERY SERVICES OF DEKALB COUNTY, INC
Other - Org Name:RECOVERY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:D
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:256-845-9220
Mailing Address - Street 1:301 GODFREY AVE. SE
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35967
Mailing Address - Country:US
Mailing Address - Phone:256-845-9220
Mailing Address - Fax:
Practice Address - Street 1:301 GODFREY AVE SE
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-1825
Practice Address - Country:US
Practice Address - Phone:256-845-9220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL339025055Medicaid