Provider Demographics
NPI:1962778217
Name:RIVER ROAD RECOVERY
Entity type:Organization
Organization Name:RIVER ROAD RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-246-7726
Mailing Address - Street 1:4324 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:STE. B130
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4481
Mailing Address - Country:US
Mailing Address - Phone:225-246-7726
Mailing Address - Fax:225-248-6691
Practice Address - Street 1:4324 S SHERWOOD FOREST BLVD
Practice Address - Street 2:STE. B130
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4481
Practice Address - Country:US
Practice Address - Phone:225-246-7726
Practice Address - Fax:225-248-6691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA499101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty