Provider Demographics
NPI:1326523366
Name:AWARE RECOVERY CARE OF MAINE LLC
Entity Type:Organization
Organization Name:AWARE RECOVERY CARE OF MAINE LLC
Other - Org Name:AWARE RECOVERY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT & COO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:LANDON
Authorized Official - Last Name:EACOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-779-5799
Mailing Address - Street 1:556 WASHINGTON AVE UNIT 201
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-1149
Mailing Address - Country:US
Mailing Address - Phone:203-779-5799
Mailing Address - Fax:203-421-6830
Practice Address - Street 1:500 SOUTHBOROUGH DR STE 500-202
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6928
Practice Address - Country:US
Practice Address - Phone:203-779-5799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AWARE RECOVERY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-26
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251E00000XAgenciesHome Health