Spirit Lake Recovery, LLC

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

4072 Issued in TN

Legal business name

SPIRIT LAKE RECOVERY, LLC

Practice address

1060 Old McKenzie Rd
MC Kenzie, TN 38201-8667

Phone

(731) 393-0304

NPI assigned

Mar 16, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Dan Sumrok, M.D.

Title

Owner

Phone

(731) 431-3010

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1237161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237161600000",
    "number": "1114168564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1060 OLD MCKENZIE RD",
            "city": "MC KENZIE",
            "state": "TN",
            "postal_code": "382018667",
            "telephone_number": "731-393-0304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1060 OLD MCKENZIE RD",
            "city": "MC KENZIE",
            "state": "TN",
            "postal_code": "382018667",
            "telephone_number": "731-393-0304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPIRIT LAKE RECOVERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-16",
        "last_updated": "2009-03-16",
        "status": "A",
        "authorized_official_last_name": "SUMROK",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "731-431-3010",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "TN",
            "license": "4072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy S Smith
• Brenda Faye Smith, PTA
• Emily Elaine Smith, MS, CCC-SLP
• Mark Thomas Smith, O.D.
• Thomas K Smith, OD
• Spivey Eye Clinic
• Aaron L Spivey III, OD
• Scott L Spivey, OD
• April Marie Stoddard, P.A.C.
• Jennifer Sturm, ATC

• Substance Abuse Rehabilitation Facility in MC Kenzie, TN
• Providers in MC Kenzie, TN by specialty
• Substance Abuse Rehabilitation Facility in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.