Provider Demographics
NPI:1821604463
Name:RECOVERY SERVICES OF THE CAROLINAS, LLC
Entity Type:Organization
Organization Name:RECOVERY SERVICES OF THE CAROLINAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:704-877-2807
Mailing Address - Street 1:10831 PINEVILLE RD STE 8
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28134-8137
Mailing Address - Country:US
Mailing Address - Phone:704-877-2807
Mailing Address - Fax:980-422-0133
Practice Address - Street 1:10831 PINEVILLE RD STE 8
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-8137
Practice Address - Country:US
Practice Address - Phone:704-877-2807
Practice Address - Fax:980-422-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty