Provider Demographics
NPI:1669130456
Name:RECOVERY4LIFE
Entity type:Organization
Organization Name:RECOVERY4LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:CLAGG
Authorized Official - Suffix:
Authorized Official - Credentials:LISW-S
Authorized Official - Phone:614-352-6807
Mailing Address - Street 1:31 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1421
Mailing Address - Country:US
Mailing Address - Phone:614-352-6807
Mailing Address - Fax:
Practice Address - Street 1:31 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1421
Practice Address - Country:US
Practice Address - Phone:614-352-6807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2024-06-17
Deactivation Date:2022-02-14
Deactivation Code:
Reactivation Date:2023-01-18
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder