Provider Demographics
NPI: | 1467027342 |
---|---|
Name: | REVCORE RECOVERY CENTER OF MANHATTAN |
Entity Type: | Organization |
Organization Name: | REVCORE RECOVERY CENTER OF MANHATTAN |
Other - Org Name: | REVCORE RECOVERY CENTER OF MANHATTAN |
Other - Org Type: | Other Name |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | AVRAHAM |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SCHICK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 212-966-9537 |
Mailing Address - Street 1: | 394 BROADWAY FL 4 |
Mailing Address - Street 2: | |
Mailing Address - City: | NEW YORK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10013-6023 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 212-966-9537 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 394 BROADWAY FL 4 |
Practice Address - Street 2: | |
Practice Address - City: | NEW YORK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10013-6023 |
Practice Address - Country: | US |
Practice Address - Phone: | 212-966-9537 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2021-05-24 |
Last Update Date: | 2023-02-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |