Provider Demographics
NPI:1588062418
Name:ATHENS ADDICTION RECOVERY CENTER, L.L.C.
Entity type:Organization
Organization Name:ATHENS ADDICTION RECOVERY CENTER, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:VEAL
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:706-559-0059
Mailing Address - Street 1:PO BOX 81485
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-1485
Mailing Address - Country:US
Mailing Address - Phone:706-559-0059
Mailing Address - Fax:706-353-1510
Practice Address - Street 1:8801 MACON HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5201
Practice Address - Country:US
Practice Address - Phone:706-559-0059
Practice Address - Fax:706-353-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPPLIED FOR261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder