Provider Demographics
NPI:1275406324
Name:STRUCTURE HOUSE RECOVERY LLC
Entity type:Organization
Organization Name:STRUCTURE HOUSE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ETHICS & COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-729-7119
Mailing Address - Street 1:PO BOX 1976
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-1976
Mailing Address - Country:US
Mailing Address - Phone:606-770-5024
Mailing Address - Fax:606-770-5025
Practice Address - Street 1:318 W DIXIE ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1939
Practice Address - Country:US
Practice Address - Phone:606-770-5024
Practice Address - Fax:606-770-5025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STRUCTURE HOUSE RECOVERY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty