Provider Demographics
NPI:1184446643
Name:RECOVERYALISTIC CORPORATION
Entity type:Organization
Organization Name:RECOVERYALISTIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONJALIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TYUS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:502-608-4471
Mailing Address - Street 1:813 S 40TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-2837
Mailing Address - Country:US
Mailing Address - Phone:502-608-4471
Mailing Address - Fax:
Practice Address - Street 1:813 S 40TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-2837
Practice Address - Country:US
Practice Address - Phone:502-608-4471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty