Provider Demographics
NPI:1891451712
Name:WELLSVILLE RECOVERY
Entity Type:Organization
Organization Name:WELLSVILLE RECOVERY
Other - Org Name:RISING RIDGE RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARLING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-731-7757
Mailing Address - Street 1:PO BOX 440
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84339-0440
Mailing Address - Country:US
Mailing Address - Phone:385-440-7048
Mailing Address - Fax:385-240-6215
Practice Address - Street 1:7877 S HWY 89-91
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84339
Practice Address - Country:US
Practice Address - Phone:385-440-7050
Practice Address - Fax:385-240-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1003005166OtherLCSW