| Recovery Mobile Clinic | |
|
3050 Steeple Road White Lake MI 48383 | |
| (248) 563-5735 | |
| Not Available |
| Full Name | Recovery Mobile Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 3050 Steeple Road, White Lake, Michigan |
| Authorized Official Name and Position | Jordana Leanne Latozas (CEO/OWNER) |
| Authorized Official Contact | 2485635735 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Recovery Mobile Clinic 7111 Dixie Hwy # 142 Clarkston MI 48346-2077 Ph: (248) 563-5735 | Recovery Mobile Clinic 3050 Steeple Road White Lake MI 48383 Ph: (248) 563-5735 |
| NPI Number | 1902431653 |
|---|---|
| Provider Enumeration Date | 03/03/2020 |
| Last Update Date | 05/21/2020 |
| Medicare PECOS PAC ID | 9032532528 |
|---|---|
| Medicare Enrollment ID | O20200630002084 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902431653 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Jordana L Latozas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831492123 PECOS PAC ID: 6305010588 Enrollment ID: I20111128000544 |
| Provider Name | Mallory Deel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790382463 PECOS PAC ID: 3870981574 Enrollment ID: I20211029001164 |
| Provider Name | Alexis Skuras |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1154003119 PECOS PAC ID: 0749636181 Enrollment ID: I20231021000361 |
| Provider Name | Kathryn Mclean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962957845 PECOS PAC ID: 1951754506 Enrollment ID: I20240130003032 |
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