Healthcare Provider Details

I. General information

NPI: 1275397515
Provider Name (Legal Business Name): MEN'S RECOVERY HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 EAST ST BLDG 34
TEWKSBURY MA
01876-1950
US

IV. Provider business mailing address

101 JACKSON ST 4TH FLOOR
LOWELL MA
01852-2103
US

V. Phone/Fax

Practice location:
  • Phone: 978-459-8658
  • Fax: 978-937-2559
Mailing address:
  • Phone: 978-459-8658
  • Fax: 978-937-2559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: LITMARIE REYES MELENDEZ
Title or Position: BILLING & CREDENTIALING ANALYST
Credential:
Phone: 978-788-8879