Self-Recovery, LLC
Organization Active NPI General Acute Care Hospital · Lanett, AL
NPI 1255409447 · NPPES record last updated Dec 9, 2024
Key facts
- NPI
- 1255409447
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- License
- 00022660 (AL)
- Legal business name
- SELF-RECOVERY, LLC
- Practice address
- 106 N Lanier Ave
Lanett, AL 36863-2014 - Phone
- (334) 644-6848
- Fax
- (334) 644-5443
- NPI assigned
- Dec 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Tommy Moore, CEO
- Title
- Owner
- Phone
- (334) 644-6848
Practitioners 13
-
Louis Divalentin, M.D.
-
Almena Free, M.D.
-
William Barton Perry, M.D.
-
Carla N Thomas, M.D.
-
Charles S Tompkins, M.D.
-
Tahir Siddiq, M.D.
-
John C Simmons, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050525000286 | AL | Part B Supplier - Clinic/Group Practice | 5597707083 |
Receives reassigned benefits from 10 practitioners Practice locations: Anniston, AL; Centre, AL; Eutaw, AL; Lanett, AL |
National Provider Directory
Locations
509 Wilson Ave
Eutaw, AL 35462
Phone (205) 372-3388
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | 00022660 | AL | Yes |
Addresses
Primary practice location
106 N Lanier Ave
Lanett, AL 36863-2014
Mailing address
106 N Lanier Ave
Lanett, AL 36863-2014
Phone (334) 644-6848
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51529504 | Other | AL | BLUE CROSS BLUE SHIELD |
| 051555920 | Medicaid | AL |
Other providers in Lanett, AL
- Lees Personal Assisted Living LLC
- Rowdy Matt Meadows
- Laura Paige Niblett
- Oasis Psychiatric Services, LLC
- Margaret Robb
- Selfrecovery
- Smile Design Center LLC
- Sheilah Sermana Soriano
- The Kroger Co
- Hannah Miller Tremlett
All providers in Lanett, AL · General Acute Care Hospital in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.