Provider Demographics
NPI:1821748849
Name:REPRISE RECOVERY LLC
Entity Type:Organization
Organization Name:REPRISE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOUNTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-204-5800
Mailing Address - Street 1:1100 BUSINESS PKWY S UNIT A
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3048
Mailing Address - Country:US
Mailing Address - Phone:443-204-5800
Mailing Address - Fax:
Practice Address - Street 1:308 LONG ISLAND AVE UNIT ABCDEF
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-4005
Practice Address - Country:US
Practice Address - Phone:443-204-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder