Provider Demographics
NPI:1700404464
Name:AWARE RECOVERY CARE OF MASSACHUSETTS, LLC
Entity Type:Organization
Organization Name:AWARE RECOVERY CARE OF MASSACHUSETTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-640-0091
Mailing Address - Street 1:35 THORPE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1948
Mailing Address - Country:US
Mailing Address - Phone:203-779-5799
Mailing Address - Fax:203-421-6830
Practice Address - Street 1:9 DAMONMILL SQ STE 105
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2858
Practice Address - Country:US
Practice Address - Phone:203-779-5799
Practice Address - Fax:203-421-6830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AWARE RECOVERY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-09
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility