Provider Demographics
NPI:1467882878
Name:POLARIS RECOVERY CENTER LLC
Entity Type:Organization
Organization Name:POLARIS RECOVERY CENTER LLC
Other - Org Name:MARYLAND ADDICTION RECOVERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-319-7041
Mailing Address - Street 1:8600 LASALLE RD.
Mailing Address - Street 2:SUITE 212
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286
Mailing Address - Country:US
Mailing Address - Phone:410-773-0500
Mailing Address - Fax:410-773-0501
Practice Address - Street 1:8600 LASALLE RD.
Practice Address - Street 2:SUITE 212
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286
Practice Address - Country:US
Practice Address - Phone:410-773-0500
Practice Address - Fax:410-773-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-21
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder