Provider Demographics
NPI:1225804552
Name:SOUTHERN MAINE RECOVERY LLC
Entity Type:Organization
Organization Name:SOUTHERN MAINE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURO
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:781-367-4650
Mailing Address - Street 1:1250 FOREST AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-6403
Mailing Address - Country:US
Mailing Address - Phone:781-367-4650
Mailing Address - Fax:
Practice Address - Street 1:408 BAR MILLS RD
Practice Address - Street 2:
Practice Address - City:HOLLIS CENTER
Practice Address - State:ME
Practice Address - Zip Code:04042-4116
Practice Address - Country:US
Practice Address - Phone:781-367-4650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder