Provider Demographics
NPI:1669090668
Name:ALTRUISTIC RECOVERY
Entity type:Organization
Organization Name:ALTRUISTIC RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:LOW
Authorized Official - Suffix:
Authorized Official - Credentials:CADC I
Authorized Official - Phone:208-550-7920
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-0658
Mailing Address - Country:US
Mailing Address - Phone:208-550-7920
Mailing Address - Fax:
Practice Address - Street 1:1052 SW 4TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2100
Practice Address - Country:US
Practice Address - Phone:208-550-7920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty