Provider Demographics
NPI:1992158323
Name:LIONHEART RECOVERY, LLC
Entity type:Organization
Organization Name:LIONHEART RECOVERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MADISON
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:678-368-5676
Mailing Address - Street 1:68 WHITE LEAF DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-6978
Mailing Address - Country:US
Mailing Address - Phone:678-368-5676
Mailing Address - Fax:
Practice Address - Street 1:68 WHITE LEAF DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-6978
Practice Address - Country:US
Practice Address - Phone:678-368-5676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health