Provider Demographics
NPI:1992468169
Name:RECOVERY CENTER OF PENNSLYVANIA, LLC
Entity Type:Organization
Organization Name:RECOVERY CENTER OF PENNSLYVANIA, LLC
Other - Org Name:RECOVERY CENTER OF OHIO, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WARRICK
Authorized Official - Middle Name:TREMAYNE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-901-4916
Mailing Address - Street 1:7345 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4472
Mailing Address - Country:US
Mailing Address - Phone:704-901-4916
Mailing Address - Fax:800-291-7239
Practice Address - Street 1:7345 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4472
Practice Address - Country:US
Practice Address - Phone:704-901-4916
Practice Address - Fax:800-291-7239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty