Provider Demographics
NPI:1790229094
Name:ADDICTION RECOVERY INC
Entity Type:Organization
Organization Name:ADDICTION RECOVERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-299-1554
Mailing Address - Street 1:429 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4127
Mailing Address - Country:US
Mailing Address - Phone:301-490-5551
Mailing Address - Fax:410-923-6213
Practice Address - Street 1:429 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4127
Practice Address - Country:US
Practice Address - Phone:301-490-5551
Practice Address - Fax:410-923-6213
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADDICTION RECOVERY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD905304320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD520204300Medicaid
MD1255607842OtherNPI NUMBER