Provider Demographics
NPI:1790951507
Name:RECOVERY WORKS OF BLOOMINGTON, LLC
Entity Type:Organization
Organization Name:RECOVERY WORKS OF BLOOMINGTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:BBA, LPN
Authorized Official - Phone:502-314-1440
Mailing Address - Street 1:417 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4613
Mailing Address - Country:US
Mailing Address - Phone:812-330-1477
Mailing Address - Fax:812-330-8755
Practice Address - Street 1:417 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-4613
Practice Address - Country:US
Practice Address - Phone:812-330-1477
Practice Address - Fax:812-330-8755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health