Bison Ridge Recovery Lodge, LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

BISON RIDGE RECOVERY LODGE, LLC

Doing business as

Bison Ridge Recovery Lodge

Practice address

224 Lavender TRL NW
Rome, GA 30165-7896

Phone

(770) 296-4555

NPI assigned

Aug 1, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Charlie Campbell

Title

President

Phone

(904) 302-3202

Specialties & licenses 1

Addresses

Other names 1

• Bison Ridge Recovery Lodge Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1722470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722470400000",
    "number": "1033948559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4451 ALABAMA HWY NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301659200",
            "telephone_number": "770-296-4555",
            "fax_number": "706-739-7276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 LAVENDER TRL NW",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301657896",
            "telephone_number": "770-296-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BISON RIDGE RECOVERY LODGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-01",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "CHARLIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-302-3202"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bison Ridge Recovery Lodge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Niki Pareshkumar Bhavsar, M.D.
• Bio-Medical Applications of Georgia, Inc.
• Bio-Medical Applications of Georgia, Inc.
• Heather Leigh Bishop
• Nitza Chea Bishop
• Joseph D. Biuso, M.D.
• BKD Rome Operator, LLC
• Damon A. Black, M.D.
• Kimberly Black, PT
• Lisa Blake, MD

• Substance Use Disorder Rehabilitation Clinic/Center in Rome, GA
• Providers in Rome, GA by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.