Provider Demographics
NPI:1992198139
Name:ADDICTION RECOVERY, INC.
Entity Type:Organization
Organization Name:ADDICTION RECOVERY, INC.
Other - Org Name:MENTAL HEALTH GROUP PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE/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:410-923-6700
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:2015-03-12
Last Update Date:2015-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD905320364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD905318OtherFACILITY LICENSE
MD813902400Medicaid