Organization
AVISTA RECOVERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES LICARI (CEO)
(630) 815-7737
Entity
Organization
Contact information
Practice address
12359 WOLF RUN RD, NOBLESVILLE, IN 46060-7232
(630) 815-7737
Mailing address
12359 WOLF RUN RD, NOBLESVILLE, IN 46060-7232
(630) 815-7737
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
12/27/2016
Last updated
12/27/2016
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