Provider Demographics
NPI:1932349487
Name:RECOVERY INNOVATIONS OF PENNSYLVANIA
Entity Type:Organization
Organization Name:RECOVERY INNOVATIONS OF PENNSYLVANIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RSA
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRODY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:814-330-1010
Mailing Address - Street 1:2701 N 16TH ST STE 316
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1266
Mailing Address - Country:US
Mailing Address - Phone:602-650-1212
Mailing Address - Fax:602-636-5211
Practice Address - Street 1:4040 MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3003
Practice Address - Country:US
Practice Address - Phone:814-330-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health