Provider Demographics
NPI:1073332185
Name:LOUISVILLE RECOVERY CENTER
Entity type:Organization
Organization Name:LOUISVILLE RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VINSON
Authorized Official - Suffix:
Authorized Official - Credentials:DBH,LPCC, LCADC, SAP
Authorized Official - Phone:706-951-4649
Mailing Address - Street 1:3830 TAYLORSVILLE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1368
Mailing Address - Country:US
Mailing Address - Phone:502-612-6998
Mailing Address - Fax:
Practice Address - Street 1:3830 TAYLORSVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1368
Practice Address - Country:US
Practice Address - Phone:502-612-6998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility