Provider Demographics
NPI:1366017816
Name:RECHARGED PERCEPTION LLC
Entity type:Organization
Organization Name:RECHARGED PERCEPTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-637-1080
Mailing Address - Street 1:3096 S HORNER BLVD STE 278
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27332-9644
Mailing Address - Country:US
Mailing Address - Phone:678-637-1080
Mailing Address - Fax:
Practice Address - Street 1:218 SIMMONS ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4841
Practice Address - Country:US
Practice Address - Phone:678-637-1080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health