Provider Demographics
NPI:1225699358
Name:MOUNT VERNON RECOVERY INC
Entity Type:Organization
Organization Name:MOUNT VERNON RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NIZNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-923-3376
Mailing Address - Street 1:1515 NW 167TH ST STE 330
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-5100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:305-930-7437
Practice Address - Street 1:521 WOOSTER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1430
Practice Address - Country:US
Practice Address - Phone:786-923-3376
Practice Address - Fax:305-930-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-28
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility