Recoverdream LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

RECOVERDREAM LLC

Doing business as

recover/DREAM

Practice address

405 Galleria Drive, Suite C
Oxford, MS 38655-4717

Phone

(662) 638-6842

Fax

(662) 638-6842

NPI assigned

Nov 11, 2021

Last updated

Jun 29, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James M Fuller III

Title

Chief Marketing Officer

Phone

(662) 638-6842

Specialties & licenses 1

Addresses

Other names 2

• recover/DREAM Doing business as
• REBOS TODAY IOP LLC Former legal business name

Locations

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

{
    "created_epoch": "1636588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1457017642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 GALLERIA DRIVE, SUITE C",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386554717",
            "telephone_number": "662-638-6842",
            "fax_number": "662-638-6842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 GALLERIA DRIVE, SUITE C",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386554717",
            "telephone_number": "662-638-6842",
            "fax_number": "662-638-6842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RECOVERDREAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-11",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF MARKETING OFFICER",
        "authorized_official_telephone_number": "662-638-6842",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "recover/DREAM",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "REBOS TODAY IOP LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Kimberly Jo Redden, AGNP
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• Substance Use Disorder Rehabilitation Clinic/Center in Oxford, MS
• Providers in Oxford, MS by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2022; 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.