NPI 1114168564

Spirit Lake Recovery, LLC

Organisation Substance Abuse Rehabilitation Facility Mc Kenzie, TN

Practice location

Address: 1060 Old McKenzie Rd, Mc Kenzie, TN 38201-8667
Phone: (731) 393-0304

Authorised official

Name: Dan Sumrok
Title: Owner
Phone: (731) 431-3010

Registered specialties

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X Licence 4072 (TN)

Other Substance Abuse Rehabilitation Facility providers in Tennessee →

Registry record

NPI: 1114168564
Entity type: Organization
NPI issued: 16 Mar 2009
Record last updated: 16 Mar 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.