Provider Demographics
NPI:1922321074
Name:RECOVERY OUTFITTERS, INC.
Entity Type:Organization
Organization Name:RECOVERY OUTFITTERS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:CASTRO
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MSCM
Authorized Official - Phone:678-947-6550
Mailing Address - Street 1:564 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9327
Mailing Address - Country:US
Mailing Address - Phone:678-947-6550
Mailing Address - Fax:888-877-6550
Practice Address - Street 1:1300 PEACHTREE PKWY
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9503
Practice Address - Country:US
Practice Address - Phone:678-947-6550
Practice Address - Fax:678-947-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA067-379-D324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility