| Recovery Technology,llc | |
|
1200 N West Ave Suite 400 Jackson MI 49202-2179 | |
| (517) 780-3336 | |
| (517) 796-4561 |
| Full Name | Recovery Technology,llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1200 N West Ave, Jackson, Michigan |
| Authorized Official Name and Position | Gregory F Gallagher (CEO) |
| Authorized Official Contact | 5177803336 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Recovery Technology,llc 1200 N West Ave Suite 400 Jackson MI 49202-2179 Ph: (517) 780-3336 | Recovery Technology,llc 1200 N West Ave Suite 400 Jackson MI 49202-2179 Ph: (517) 780-3336 |
| NPI Number | 1205004298 |
|---|---|
| Provider Enumeration Date | 02/13/2008 |
| Last Update Date | 04/30/2008 |
| Medicare PECOS PAC ID | 3779660493 |
|---|---|
| Medicare Enrollment ID | O20080404000670 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205004298 | NPI | - | NPPES |
| 4970942 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Mitzi A Diesing |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073568374 PECOS PAC ID: 5496725723 Enrollment ID: I20040726001365 |
| Provider Name | Dawn Louise Del Rio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952356081 PECOS PAC ID: 7113998550 Enrollment ID: I20040802000312 |
| Provider Name | Violetta A Kaminska-galecka |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053425736 PECOS PAC ID: 2567431604 Enrollment ID: I20040928000110 |
| Provider Name | Masood Ahmad |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1366481905 PECOS PAC ID: 4981600160 Enrollment ID: I20091208000340 |
| Provider Name | Devin J Dombrowski |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003143512 PECOS PAC ID: 9032369087 Enrollment ID: I20121029000130 |
| Provider Name | Jessica Bemer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1740668466 PECOS PAC ID: 1658659578 Enrollment ID: I20161027002453 |
| Provider Name | Jill A Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316432032 PECOS PAC ID: 2860741121 Enrollment ID: I20180820001623 |
| Provider Name | Shannon L Gilson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477052579 PECOS PAC ID: 9335551860 Enrollment ID: I20201207002483 |
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