Provider Demographics
NPI:1437434990
Name:ADDICTION RECOVERY, INC.
Entity Type:Organization
Organization Name:ADDICTION RECOVERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:D'SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-923-6700
Mailing Address - Street 1:PO BOX 546
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-0546
Mailing Address - Country:US
Mailing Address - Phone:410-923-6700
Mailing Address - Fax:410-923-6213
Practice Address - Street 1:419 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4127
Practice Address - Country:US
Practice Address - Phone:301-490-5551
Practice Address - Fax:301-490-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD904339324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD420835800Medicaid