MEDICARE: ASPEN 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1649048455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASPEN RECOVERY

Provider Business Mailing Address
First Line	:	279 OAKLEY AVE
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5025
Country	:	US
Telephone Number	:	646-667-5615
Fax Number	:

Provider Business Practice Location Address
First Line	:	279 OAKLEY AVE
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-5025
Country	:	US
Telephone Number	:	646-667-5615
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KASRIEL NOJOWITZ
Credential	:
Telephone Number	:	646-667-5615

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	12/12/2023

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