Provider Demographics
NPI:1629363015
Name:C. C. RECOVERY, INC.
Entity Type:Organization
Organization Name:C. C. RECOVERY, INC.
Other - Org Name:CECIL COUNTY RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:LASTRAPES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-724-1144
Mailing Address - Street 1:722 E PULASKI HWY
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6029
Mailing Address - Country:US
Mailing Address - Phone:301-724-1144
Mailing Address - Fax:301-724-2268
Practice Address - Street 1:722 E PULASKI HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6029
Practice Address - Country:US
Practice Address - Phone:301-724-1144
Practice Address - Fax:301-724-2268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDOO65625261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone