Healthcare Provider Details

I. General information

NPI: 1992331821
Provider Name (Legal Business Name): METANOIA RECOVERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CONCORD ST
NORTH READING MA
01864-2640
US

IV. Provider business mailing address

15 WARREN ST
STONEHAM MA
02180-3557
US

V. Phone/Fax

Practice location:
  • Phone: 774-479-1151
  • Fax:
Mailing address:
  • Phone: 774-479-1151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: EDWARD LEPAGE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 774-479-1151