Provider Demographics
NPI:1912457664
Name:TALBOT RECOVERY CAMPUS
Entity Type:Organization
Organization Name:TALBOT RECOVERY CAMPUS
Other - Org Name:TALBOTT RECOVERY CAMPUS
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:ORSINI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:678-251-3211
Mailing Address - Street 1:PO BOX 2007
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49501-2007
Mailing Address - Country:US
Mailing Address - Phone:678-251-3211
Mailing Address - Fax:770-970-2195
Practice Address - Street 1:5448 YORKTOWNE DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5317
Practice Address - Country:US
Practice Address - Phone:678-251-3211
Practice Address - Fax:770-970-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031443D251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health