Provider Demographics
NPI:1902431653
Name:RECOVERY MOBILE CLINIC
Entity Type:Organization
Organization Name:RECOVERY MOBILE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JORDANA
Authorized Official - Middle Name:LEANNE
Authorized Official - Last Name:LATOZAS
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:248-563-5735
Mailing Address - Street 1:7111 DIXIE HWY # 142
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346-2077
Mailing Address - Country:US
Mailing Address - Phone:248-563-5735
Mailing Address - Fax:
Practice Address - Street 1:3050 STEEPLE ROAD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48383
Practice Address - Country:US
Practice Address - Phone:248-563-5735
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-03
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center