Spirit Lake Recovery, LLC
Substance Abuse Rehabilitation Facility in Mc Kenzie, TN. Organization (NPI-2).
NPI number1114168564
StatusActive
Last updated in NPPESMar 16, 2009
Details
- NPI
- 1114168564
- Entity type
- Organization (NPI-2)
- Legal business name
- Spirit Lake Recovery, LLC
- Organization subpart
- No
- Enumeration date
- Mar 16, 2009
- Last updated
- Mar 16, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 324500000X | Substance Abuse Rehabilitation Facility | 4072 | TN | Yes |
Practice location
1060 Old McKenzie RdMc Kenzie, TN 38201-8667
Phone 731-393-0304
Mailing address
1060 Old McKenzie RdMc Kenzie, TN 38201-8667
Phone 731-393-0304
Authorized official
Dan Sumrok
Owner
7314313010
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