Provider Demographics
NPI:1730934357
Name:WARRIORS RESPITE, LLC
Entity type:Organization
Organization Name:WARRIORS RESPITE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSW, LCSW, CADC
Authorized Official - Phone:630-730-6405
Mailing Address - Street 1:5015 US HWY 41
Mailing Address - Street 2:PMB 141
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4711
Mailing Address - Country:US
Mailing Address - Phone:812-251-5034
Mailing Address - Fax:
Practice Address - Street 1:109 ALLENDALE LN
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4704
Practice Address - Country:US
Practice Address - Phone:812-251-5034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty