Provider Demographics
NPI:1003473646
Name:RECOVERY & WELLNESS CENTER, LLC.
Entity Type:Organization
Organization Name:RECOVERY & WELLNESS CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DECAROLIS
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:917-751-8700
Mailing Address - Street 1:605 GROVE ST APT D1
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3867
Mailing Address - Country:US
Mailing Address - Phone:917-751-8700
Mailing Address - Fax:
Practice Address - Street 1:218 LORRAINE AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1915
Practice Address - Country:US
Practice Address - Phone:917-751-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty