Provider Demographics
NPI:1922206325
Name:MONTGOMERY RECOVERY SERVICES, INC
Entity Type:Organization
Organization Name:MONTGOMERY RECOVERY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SPONSOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:CCDC
Authorized Official - Phone:301-762-5300
Mailing Address - Street 1:14636 ROTHGEB DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5394
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14636 ROTHGEB DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5394
Practice Address - Country:US
Practice Address - Phone:301-762-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD903006261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone