Organization
SPIRIT LAKE RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAN SUMROK M.D. (OWNER)
(731) 431-3010
Entity
Organization
Contact information
Practice address
1060 OLD MCKENZIE RD, MC KENZIE, TN 38201-8667
(731) 393-0304
Mailing address
1060 OLD MCKENZIE RD, MC KENZIE, TN 38201-8667
(731) 393-0304
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
4072
TN
Other
Enumeration date
03/16/2009
Last updated
03/16/2009
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