Provider Demographics
NPI:1205076759
Name:RECOVERY SERVICES CENTER
Entity type:Organization
Organization Name:RECOVERY SERVICES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCP
Authorized Official - Phone:785-242-2991
Mailing Address - Street 1:109 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:KS
Mailing Address - Zip Code:66067-2212
Mailing Address - Country:US
Mailing Address - Phone:785-242-2991
Mailing Address - Fax:785-242-4401
Practice Address - Street 1:109 W 2ND ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-2212
Practice Address - Country:US
Practice Address - Phone:785-242-2991
Practice Address - Fax:785-242-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS06940878261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center