Provider Demographics
NPI:1457791634
Name:ROAD TO RECOVERY
Entity Type:Organization
Organization Name:ROAD TO RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCS, CADC
Authorized Official - Phone:208-233-2492
Mailing Address - Street 1:343 E BONNEVILLE ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6434
Mailing Address - Country:US
Mailing Address - Phone:208-233-9135
Mailing Address - Fax:208-233-9136
Practice Address - Street 1:343 E BONNEVILLE ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6434
Practice Address - Country:US
Practice Address - Phone:208-233-9135
Practice Address - Fax:208-233-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health