Provider Demographics
NPI:1336687565
Name:GREAT ISLAND RECOVERY
Entity Type:Organization
Organization Name:GREAT ISLAND RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CECILY
Authorized Official - Middle Name:H
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:LADC, MSW
Authorized Official - Phone:207-329-5615
Mailing Address - Street 1:57 EXCHANGE ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-5000
Mailing Address - Country:US
Mailing Address - Phone:207-329-5615
Mailing Address - Fax:
Practice Address - Street 1:57 EXCHANGE ST
Practice Address - Street 2:STE. 100
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-5000
Practice Address - Country:US
Practice Address - Phone:207-329-5615
Practice Address - Fax:207-536-1615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4288101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty