Provider Demographics
NPI:1609695477
Name:REALCOVERY LLC
Entity type:Organization
Organization Name:REALCOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-989-9180
Mailing Address - Street 1:2067 4TH AVE E
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7405
Mailing Address - Country:US
Mailing Address - Phone:503-989-9180
Mailing Address - Fax:
Practice Address - Street 1:2091 4TH AVE E
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-7405
Practice Address - Country:US
Practice Address - Phone:208-731-7354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility