Healthcare Provider Details

I. General information

NPI: 1811782733
Provider Name (Legal Business Name): RECOVERY180 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 SOUTHERN AVE
BALTIMORE MD
21214-3221
US

IV. Provider business mailing address

1100 BUSINESS PKWY S STE 1
WESTMINSTER MD
21157-3048
US

V. Phone/Fax

Practice location:
  • Phone: 443-289-8606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation 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: DESIREE N MOUNTAIN
Title or Position: COMPLIANCE
Credential:
Phone: 443-289-8606