Provider Demographics
NPI:1871126128
Name:TMJJW LLC DBA TOTAL RECOVERY IN PROGRESS
Entity type:Organization
Organization Name:TMJJW LLC DBA TOTAL RECOVERY IN PROGRESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:CADC-S,LICDC-CS,ICCS
Authorized Official - Phone:513-673-0228
Mailing Address - Street 1:3192 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018
Mailing Address - Country:US
Mailing Address - Phone:859-609-1011
Mailing Address - Fax:859-331-0649
Practice Address - Street 1:3192 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018
Practice Address - Country:US
Practice Address - Phone:859-609-1011
Practice Address - Fax:859-331-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-14
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100965770Medicaid