Healthcare Provider Details

I. General information

NPI: 1922684034
Provider Name (Legal Business Name): IGNITE RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 FRENCH ST
FALL RIVER MA
02720-5441
US

IV. Provider business mailing address

672 BEDFORD ST
FALL RIVER MA
02720-4828
US

V. Phone/Fax

Practice location:
  • Phone: 508-717-2827
  • Fax:
Mailing address:
  • Phone: 508-296-0523
  • Fax: 508-290-0062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: LAURA GOODE
Title or Position: OWNER
Credential:
Phone: 508-717-2827