Provider Demographics
NPI:1295303444
Name:LEDBETTER RECOVERY SERVICES. LLC
Entity type:Organization
Organization Name:LEDBETTER RECOVERY SERVICES. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS
Authorized Official - Phone:980-474-0117
Mailing Address - Street 1:2015 DONEGAL CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-6702
Mailing Address - Country:US
Mailing Address - Phone:980-474-0117
Mailing Address - Fax:
Practice Address - Street 1:310 W THIRD AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4004
Practice Address - Country:US
Practice Address - Phone:704-868-8644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEDBETTER RECOVERY SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-15
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder