Provider Demographics
NPI:1699486357
Name:RECOVERY BOUND
Entity type:Organization
Organization Name:RECOVERY BOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KHALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-310-9109
Mailing Address - Street 1:511 BELLE CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:IL
Mailing Address - Zip Code:60426-2312
Mailing Address - Country:US
Mailing Address - Phone:708-310-9109
Mailing Address - Fax:708-331-4602
Practice Address - Street 1:509 BELLE CT
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:IL
Practice Address - Zip Code:60426-2312
Practice Address - Country:US
Practice Address - Phone:708-310-9109
Practice Address - Fax:708-331-4602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management