MEDICARE: STERLING RECOVERY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1093335929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STERLING RECOVERY, LLC

Provider Business Mailing Address
First Line	:	3758 AMBER ST NE #105
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301
Country	:	US
Telephone Number	:	971-273-8668
Fax Number	:	833-390-2537

Provider Business Practice Location Address
First Line	:	3758 AMBER ST NE #105
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97301
Country	:	US
Telephone Number	:	971-273-8668
Fax Number	:	833-390-2537

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA ELIZABETH SHORT
Credential	:	RDN, LD
Telephone Number	:	971-273-8668

Provider Enumeration Date	:	04/21/2020
Last Update Date	:	04/21/2020

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