Lincoln Nova Vital Recovery Center,llc
Substance Abuse Rehabilitation Facility in Ruston, LA. Organization (NPI-2).
NPI number1043780851
StatusActive
Last updated in NPPESMar 19, 2025
Details
- NPI
- 1043780851
- Entity type
- Organization (NPI-2)
- Legal business name
- Lincoln Nova Vital Recovery Center,llc
- Organization subpart
- No
- Enumeration date
- Dec 5, 2018
- Certification date
- Mar 19, 2025
- Last updated
- Mar 19, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 324500000X | Substance Abuse Rehabilitation Facility | – | – | Yes |
| 251S00000X | Community/Behavioral Health | – | – | |
| 261QR0405X | Clinic/Center, Rehabilitation, Substance Use Disorder | – | – | |
| 276400000X | Rehabilitation, Substance Use Disorder Unit | – | – |
Practice location
4396 Highway 80Ruston, LA 71270-8948
Phone 318-251-4659 · Fax 318-251-4659
Mailing address
8520 Business Park DrShreveport, LA 71105-5654
Phone 318-251-4659 · Fax 318-251-4659
Authorized official
Denny E. Gamble
Owner
3182514659
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