Provider Demographics
NPI:1538946223
Name:REDFOX RECOVER CENTER
Entity type:Organization
Organization Name:REDFOX RECOVER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:160-643-8585
Mailing Address - Street 1:995 BREEDING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDFOX
Mailing Address - State:KY
Mailing Address - Zip Code:41847
Mailing Address - Country:US
Mailing Address - Phone:160-643-8585
Mailing Address - Fax:
Practice Address - Street 1:995 BREEDING CREEK RD
Practice Address - Street 2:
Practice Address - City:REDFOX
Practice Address - State:KY
Practice Address - Zip Code:41847
Practice Address - Country:US
Practice Address - Phone:160-643-8585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care