Provider Demographics
NPI:1144830027
Name:RECOVERY JOURNEY SERVICES LLC
Entity type:Organization
Organization Name:RECOVERY JOURNEY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYEASIA
Authorized Official - Middle Name:KIAH
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCAS CCS
Authorized Official - Phone:252-378-9940
Mailing Address - Street 1:2054 FISHPOND RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-8852
Mailing Address - Country:US
Mailing Address - Phone:252-814-5095
Mailing Address - Fax:
Practice Address - Street 1:201 E PITT ST STE 103
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-5137
Practice Address - Country:US
Practice Address - Phone:252-378-9940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC00586698Medicaid