Provider Demographics
NPI:1275323255
Name:PILLAR RECOVERY SERVICES
Entity type:Organization
Organization Name:PILLAR RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TRENT
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:904-399-6165
Mailing Address - Street 1:43663 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-2516
Mailing Address - Country:US
Mailing Address - Phone:904-399-6165
Mailing Address - Fax:
Practice Address - Street 1:43663 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-2516
Practice Address - Country:US
Practice Address - Phone:904-399-6165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52025730Medicaid
MI4704423743OtherMICHIGAN DEPT. OF LICENSING & REGULATORY AFFAIRS - BUREAU OF PROF. LICENSING