Provider Demographics
NPI:1821525551
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 1:419 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:301-490-2517
Practice Address - Street 1:419 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:301-490-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD906329324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD906329OtherSTATE LICENSE