Provider Demographics
NPI:1760596746
Name:RECOVERY CONCEPTS LLC
Entity type:Organization
Organization Name:RECOVERY CONCEPTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GAJENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAFNA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:864-631-7371
Mailing Address - Street 1:124 BOARDWALK DR STE A
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:SC
Mailing Address - Zip Code:29936-7994
Mailing Address - Country:US
Mailing Address - Phone:843-645-2770
Mailing Address - Fax:843-645-2771
Practice Address - Street 1:124 BOARDWALK DR STE A
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:SC
Practice Address - Zip Code:29936-7994
Practice Address - Country:US
Practice Address - Phone:843-645-2770
Practice Address - Fax:843-645-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
2093069OtherPK