Healthcare Provider Details

I. General information

NPI: 1750938171
Provider Name (Legal Business Name): ALPHA RECOVERY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 STEVENS RD
NORTH READING MA
01864-3216
US

IV. Provider business mailing address

16 STEVENS RD
NORTH READING MA
01864-3216
US

V. Phone/Fax

Practice location:
  • Phone: 617-435-9783
  • Fax:
Mailing address:
  • Phone: 617-435-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW GANEM
Title or Position: OWNER, OPERATOR
Credential:
Phone: 617-435-9783