Organization
LINCOLN NOVA VITAL RECOVERY CENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNY E. GAMBLE JR. FACHCA (OWNER)
(318) 251-4659
Entity
Organization
Contact information
Practice address
4396 HIGHWAY 80, RUSTON, LA 71270-8948
(318) 251-4659
(318) 251-4659
Mailing address
8520 BUSINESS PARK DR, SHREVEPORT, LA 71105-5654
(318) 251-4659
(318) 251-4659
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
276400000X
Substance Use Disorder Rehabilitation Hospital Unit
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1336348317
251S00000X
—
Enumeration date
12/05/2018
Last updated
03/19/2025
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