Healthcare Provider Details

I. General information

NPI: 1871714501
Provider Name (Legal Business Name): RECOVERY NETWORK OF PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 06/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1438 PARK AVE
BRIDGEPORT CT
06604-2512
US

IV. Provider business mailing address

2 TRAP FALLS RD SUITE 405
SHELTON CT
06484-4616
US

V. Phone/Fax

Practice location:
  • Phone: 203-335-2173
  • Fax: 203-333-0754
Mailing address:
  • Phone: 203-929-1954
  • Fax: 203-929-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number0237
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number0237
License Number StateCT

VIII. Authorized Official

Name: MR. JOHN HAMILTON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 203-929-1954