Provider Demographics
NPI:1538634829
Name:4TH DIMENSION RECOVERY CENTERS
Entity Type:Organization
Organization Name:4TH DIMENSION RECOVERY CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-642-3030
Mailing Address - Street 1:1216 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3061
Mailing Address - Country:US
Mailing Address - Phone:973-277-5359
Mailing Address - Fax:
Practice Address - Street 1:1216 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3061
Practice Address - Country:US
Practice Address - Phone:973-277-5359
Practice Address - Fax:928-441-1686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-12
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder