Provider Demographics
NPI:1992339261
Name:ADDICTION RECOVERY CENTER, LLC
Entity type:Organization
Organization Name:ADDICTION RECOVERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNELL
Authorized Official - Middle Name:B
Authorized Official - Last Name:KALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-243-4164
Mailing Address - Street 1:PO BOX 254
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-0254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:516 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-2117
Practice Address - Country:US
Practice Address - Phone:785-243-4164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder