Organization
SELF-RECOVERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOMMY MOORE CEO (OWNER)
(334) 644-6848
Entity
Organization
Contact information
Practice address
106 N LANIER AVE, LANETT, AL 36863-2014
(334) 644-6848
(334) 644-5443
Mailing address
106 N LANIER AVE, LANETT, AL 36863-2014
(334) 644-6848
(334) 644-5543
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
00022660
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051555920
—
AL
01
—
51529504
BLUE CROSS BLUE SHIELD
AL
Enumeration date
12/04/2006
Last updated
12/09/2024
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