Provider Demographics
NPI:1922617133
Name:RECOVERY CONCEPTS URBANA, LLC
Entity Type:Organization
Organization Name:RECOVERY CONCEPTS URBANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKINEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-335-1155
Mailing Address - Street 1:12489 JOSEPHS RD
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:LA
Mailing Address - Zip Code:70437-5829
Mailing Address - Country:US
Mailing Address - Phone:985-705-3263
Mailing Address - Fax:
Practice Address - Street 1:710 W. KILLARNEY ST.
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:985-705-3263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVERY CONCEPTS HOLDINGS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILA-3516-0001-AOtherSUPR ILLINOIS
ILA-3516-0001-AMedicaid