Provider Demographics
NPI:1710237052
Name:ROAD TO RECOVERY BEHAVORIAL HEALTH CLINIC, LLC
Entity Type:Organization
Organization Name:ROAD TO RECOVERY BEHAVORIAL HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, SAC
Authorized Official - Phone:414-258-7872
Mailing Address - Street 1:7441 W GREENFIELD AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4676
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7441 W GREENFIELD AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4676
Practice Address - Country:US
Practice Address - Phone:414-258-7872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)