MEDICARE: KINGS 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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1184557019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS RECOVERY LLC

Provider Business Mailing Address
First Line	:	1711 E FEDERAL ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21213-3106
Country	:	US
Telephone Number	:	410-215-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 E FEDERAL ST
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21213-3106
Country	:	US
Telephone Number	:	410-215-1111
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANDRE MATTHEWS
Credential	:
Telephone Number	:	410-215-1111

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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Directions to “KINGS RECOVERY LLC ” Practice Location

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