Provider Demographics
NPI:1497331102
Name:BEAR ISLAND RECOVERY SERVICES, INC.
Entity Type:Organization
Organization Name:BEAR ISLAND RECOVERY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GRADY
Authorized Official - Middle Name:B
Authorized Official - Last Name:JEFFERYS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:828-273-1643
Mailing Address - Street 1:722 CEDAR POINT BLVD
Mailing Address - Street 2:PMB 242
Mailing Address - City:CEDAR
Mailing Address - State:NC
Mailing Address - Zip Code:28584
Mailing Address - Country:US
Mailing Address - Phone:828-273-1643
Mailing Address - Fax:
Practice Address - Street 1:1150 CEDAR POINT BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR POINT
Practice Address - State:NC
Practice Address - Zip Code:28584-8022
Practice Address - Country:US
Practice Address - Phone:828-273-1643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone