Provider Demographics
NPI:1942670336
Name:MILESTONE RECOVERY LLC
Entity Type:Organization
Organization Name:MILESTONE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRACK
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERYS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-273-1643
Mailing Address - Street 1:225 N MAIN ST # B
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NC
Mailing Address - Zip Code:27371-3061
Mailing Address - Country:US
Mailing Address - Phone:704-207-6266
Mailing Address - Fax:
Practice Address - Street 1:2001 WALNUT LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-7333
Practice Address - Country:US
Practice Address - Phone:704-207-6266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QM0801X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)