Provider Demographics
NPI:1902181654
Name:EMH RECOVERY, INC.
Entity Type:Organization
Organization Name:EMH RECOVERY, INC.
Other - Org Name:EDWINA MARTIN HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LADC-1, MED
Authorized Official - Phone:508-583-0493
Mailing Address - Street 1:678 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2444
Mailing Address - Country:US
Mailing Address - Phone:508-583-0493
Mailing Address - Fax:508-583-4317
Practice Address - Street 1:678 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2444
Practice Address - Country:US
Practice Address - Phone:508-583-0493
Practice Address - Fax:508-583-4317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0201324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0201Medicaid