Provider Demographics
NPI:1609614379
Name:SHADOWROCK RECOVERY
Entity type:Organization
Organization Name:SHADOWROCK RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:MML
Authorized Official - Phone:606-303-0785
Mailing Address - Street 1:2720 OLD ROSEBUD RD STE 360
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8004
Mailing Address - Country:US
Mailing Address - Phone:606-303-0785
Mailing Address - Fax:
Practice Address - Street 1:2720 OLD ROSEBUD RD STE 360
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8004
Practice Address - Country:US
Practice Address - Phone:606-303-0785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-17
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility