Provider Demographics
NPI:1720589286
Name:MIDWEST RECOVERY AND WELLNESS LLC
Entity Type:Organization
Organization Name:MIDWEST RECOVERY AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:269-635-2396
Mailing Address - Street 1:2527 S 11TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-4747
Mailing Address - Country:US
Mailing Address - Phone:269-635-2396
Mailing Address - Fax:
Practice Address - Street 1:2527 S 11TH ST STE 2
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-4747
Practice Address - Country:US
Practice Address - Phone:269-262-1815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0140016261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)