Provider Demographics
NPI:1104460666
Name:ACTIVE RECOVERY, LLC
Entity type:Organization
Organization Name:ACTIVE RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:HORI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:801-628-4944
Mailing Address - Street 1:25 S MAIN ST # 212
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1840
Mailing Address - Country:US
Mailing Address - Phone:801-663-6656
Mailing Address - Fax:
Practice Address - Street 1:25 S MAIN ST # 212
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1840
Practice Address - Country:US
Practice Address - Phone:801-663-6656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility