Provider Demographics
NPI:1891154399
Name:ROAD TO RECOVERY, LLC
Entity type:Organization
Organization Name:ROAD TO RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SPONSOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:BESTE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:303-434-8484
Mailing Address - Street 1:393 S HARLAN ST STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3582
Mailing Address - Country:US
Mailing Address - Phone:303-521-7395
Mailing Address - Fax:
Practice Address - Street 1:393 S HARLAN ST
Practice Address - Street 2:STE 105
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3572
Practice Address - Country:US
Practice Address - Phone:303-434-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-12
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13542084A0401X
CO261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty