Provider Demographics
NPI:1831748573
Name:RECOVERUSCENTERS-CARBONDALE LLC
Entity type:Organization
Organization Name:RECOVERUSCENTERS-CARBONDALE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILTON
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:MORTER
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:479-619-9320
Mailing Address - Street 1:2250 REED STATION PKWY STE 204
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-8104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2250 REED STATION PKWY STE 204
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-8104
Practice Address - Country:US
Practice Address - Phone:618-519-9445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty