Provider Demographics
NPI:1669134722
Name:RECOVERY LIFE GROUP LLC
Entity type:Organization
Organization Name:RECOVERY LIFE GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-343-8095
Mailing Address - Street 1:14535 CANDY HILL RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-8054
Mailing Address - Country:US
Mailing Address - Phone:301-343-8095
Mailing Address - Fax:
Practice Address - Street 1:14535 CANDY HILL RD
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-8054
Practice Address - Country:US
Practice Address - Phone:301-343-8095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty