Provider Demographics
NPI:1205640844
Name:PRODUCE OPPORTUNITIES WHICH EMBRACE REHABILITATION POWER LLC
Entity type:Organization
Organization Name:PRODUCE OPPORTUNITIES WHICH EMBRACE REHABILITATION POWER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:410-240-4174
Mailing Address - Street 1:1 ROLLWIN RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2835
Mailing Address - Country:US
Mailing Address - Phone:410-240-4174
Mailing Address - Fax:
Practice Address - Street 1:2914 KILDAIRE DR
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-7639
Practice Address - Country:US
Practice Address - Phone:410-240-4174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility