Organization
LANDMARK RECOVERY OUTPATIENT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICHOLAS JAMES LOSOLE (PRESIDENT, OUTPATIENT SERVICES)
(480) 550-2163
Entity
Organization
Contact information
Practice address
4112 FERN VALLEY RD STE B, LOUISVILLE, KY 40219-1973
(502) 221-3932
(502) 964-2682
Mailing address
4835 E CACTUS RD STE 130, SCOTTSDALE, AZ 85254-3545
(480) 551-2163
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
800286
LICENSE
KY
Enumeration date
07/25/2018
Last updated
04/30/2019
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