Provider Demographics
NPI:1891492914
Name:PLATINUM RECOVERY LLC
Entity Type:Organization
Organization Name:PLATINUM RECOVERY LLC
Other - Org Name:PLATINUM RECOVERY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-944-4047
Mailing Address - Street 1:1560 E FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-3836
Mailing Address - Country:US
Mailing Address - Phone:229-944-4047
Mailing Address - Fax:229-944-4048
Practice Address - Street 1:1560 E FORSYTH ST APT D
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3836
Practice Address - Country:US
Practice Address - Phone:229-944-4047
Practice Address - Fax:229-944-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone