Provider Demographics
NPI:1457790776
Name:RECOVERY COACHING SERVICE OF NEW YORK, LLC
Entity Type:Organization
Organization Name:RECOVERY COACHING SERVICE OF NEW YORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCIOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:CARC
Authorized Official - Phone:718-514-4560
Mailing Address - Street 1:201 W 122ND ST
Mailing Address - Street 2:504
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-5410
Mailing Address - Country:US
Mailing Address - Phone:718-514-4560
Mailing Address - Fax:
Practice Address - Street 1:201 W 122ND ST
Practice Address - Street 2:504
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-5410
Practice Address - Country:US
Practice Address - Phone:718-514-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-19
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management