Provider Demographics
NPI:1942880232
Name:RECOVER COLLABORATIVE
Entity Type:Organization
Organization Name:RECOVER COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING AND FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:GRILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-698-8694
Mailing Address - Street 1:23 KERRY PARK
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-2613
Mailing Address - Country:US
Mailing Address - Phone:585-698-8694
Mailing Address - Fax:
Practice Address - Street 1:23 KERRY PARK
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-2613
Practice Address - Country:US
Practice Address - Phone:585-698-8694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-11
Last Update Date:2021-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
No174200000XOther Service ProvidersMeals
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1932721271Medicaid