Healthcare Provider Details

I. General information

NPI: 1609729581
Provider Name (Legal Business Name): COMMONWEALTH RECOVERY CLINIC-INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2026
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 DOVER ST STE 301
NEW BEDFORD MA
02740-6258
US

IV. Provider business mailing address

5 DOVER ST STE 301
NEW BEDFORD MA
02740-6258
US

V. Phone/Fax

Practice location:
  • Phone: 617-230-6824
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TEKUM PENTOCOSTER
Title or Position: CEO
Credential:
Phone: 617-230-6824