Provider Demographics
NPI:1356611289
Name:RECOVERY EDGE PEER SUPPORT AND RECOVERY SERVICES, INC.
Entity type:Organization
Organization Name:RECOVERY EDGE PEER SUPPORT AND RECOVERY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:PERHONITCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:CPS/FORENSIC SPECIAL
Authorized Official - Phone:570-621-8533
Mailing Address - Street 1:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:FRIEDENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17933-0018
Mailing Address - Country:US
Mailing Address - Phone:570-621-8533
Mailing Address - Fax:
Practice Address - Street 1:18 N 2ND ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2903
Practice Address - Country:US
Practice Address - Phone:570-516-9094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA223720251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health