Provider Demographics
NPI:1649967795
Name:RECOVERY SOLDIERS MINISTRIES
Entity type:Organization
Organization Name:RECOVERY SOLDIERS MINISTRIES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINCOLN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,MHSP
Authorized Official - Phone:423-747-3803
Mailing Address - Street 1:1180 BRISTOL HWY
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-6684
Mailing Address - Country:US
Mailing Address - Phone:423-747-3803
Mailing Address - Fax:
Practice Address - Street 1:1180 BRISTOL HWY
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-6684
Practice Address - Country:US
Practice Address - Phone:423-747-3803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVERY SOLDIERS MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-19
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty