Basic Information
| Provider Information | |||||||||
| NPI: | 1245902576 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KNOX RECOVERY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 113 W GAMBIER ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430502421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403269099 | ||||||||
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| Practice Location | |||||||||
| Address1: | 113 W GAMBIER ST | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430502421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403269099 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2021 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | WELLS | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7403269099 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CDCA | ||||||||
| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.