MEDICARE: PARKERSBURG ADDICTION RECOVERY

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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1558971341
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARKERSBURG ADDICTION RECOVERY

Provider Business Mailing Address
First Line	:	2910 EMERSON AVE
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26104-2519
Country	:	US
Telephone Number	:	740-856-1084
Fax Number	:	304-699-1923

Provider Business Practice Location Address
First Line	:	2910 EMERSON AVE
Second Line	:
City	:	PARKERSBURG
State	:	WV
Zip	:	26104-2519
Country	:	US
Telephone Number	:	304-239-5355
Fax Number	:	304-699-1923

Authorized Official
Title or Position	:	CEO
Name	:	MERANDA S MURPHY
Credential	:
Telephone Number	:	740-856-1084

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	01/27/2023

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Directions to “PARKERSBURG ADDICTION RECOVERY ” Practice Location

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