NPIMap

Organization Active NPI

Recovery Mobile Clinic

  • Acute Care Nurse Practitioner
  • Wixom, MI
National Provider Identifier
1902431653
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
Legal business name
RECOVERY MOBILE CLINIC
Practice address
4706 Product Dr Ste 1
Wixom, MI 48393-2071
Phone
(248) 567-2334
NPI assigned
Mar 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

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

Authorized official

Name
Mrs. Jordana Leanne Latozas, ACNPNPI 1831492123
Title
Ceo/Owner
Phone
(248) 563-5735

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Acute Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2100X Primary

Addresses

Primary practice location

4706 Product Dr Ste 1
Wixom, MI 48393-2071

Mailing address

7111 Dixie Hwy # 142
Clarkston, MI 48346-2077
Phone (248) 563-5735

Other practice location 1

1188 Wheaton Dr
Troy, MI 48083-1953
Phone (248) 567-2334

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200630002084 MI Part B Supplier - Clinic/Group Practice 9032532528 Receives reassigned benefits from 9 practitioners
Practice locations: White Lake, MI

National Provider Directory

National Provider Directory

Locations

1188 Wheaton Dr
Troy, MI 48083
Phone (248) 567-2334

4706 Product Dr
Ste 1
Wixom, MI 48393
Phone (248) 567-2334

4706 Product Dr
Ste 3
Wixom, MI 48393

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764720000000",
    "number": "1902431653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7111 DIXIE HWY # 142",
            "city": "CLARKSTON",
            "state": "MI",
            "postal_code": "483462077",
            "telephone_number": "248-563-5735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4706 PRODUCT DR STE 1",
            "city": "WIXOM",
            "state": "MI",
            "postal_code": "483932071",
            "telephone_number": "248-567-2334"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1188 Wheaton Dr",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "MI",
            "postal_code": "480831953",
            "country_code": "US",
            "telephone_number": "248-567-2334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "RECOVERY MOBILE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-03",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A",
        "authorized_official_last_name": "LATOZAS",
        "authorized_official_first_name": "JORDANA",
        "authorized_official_middle_name": "LEANNE",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "248-563-5735",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ACNP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wixom, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.