Provider Demographics
NPI:1750822847
Name:MOMENTUM RECOVERY LLC
Entity Type:Organization
Organization Name:MOMENTUM RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINCAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCAS, MAC, CCS
Authorized Official - Phone:828-772-6121
Mailing Address - Street 1:5027 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-7046
Mailing Address - Country:US
Mailing Address - Phone:828-772-6121
Mailing Address - Fax:
Practice Address - Street 1:5027 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-7046
Practice Address - Country:US
Practice Address - Phone:888-815-5502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-09
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-065-257324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility