Provider Demographics
NPI:1326811506
Name:METANOIA RECOVERY COLLECTIVE
Entity Type:Organization
Organization Name:METANOIA RECOVERY COLLECTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT/PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NASHAWATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-690-9020
Mailing Address - Street 1:22 REDLON RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2218
Mailing Address - Country:US
Mailing Address - Phone:617-690-9020
Mailing Address - Fax:
Practice Address - Street 1:56 MOSHER ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2122
Practice Address - Country:US
Practice Address - Phone:617-690-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility