Healthcare Provider Details

I. General information

NPI: 1821748849
Provider Name (Legal Business Name): REPRISE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 LONG ISLAND AVE UNIT ABCDEF
BALTIMORE MD
21229-4005
US

IV. Provider business mailing address

1100 BUSINESS PKWY S UNIT A
WESTMINSTER MD
21157-3048
US

V. Phone/Fax

Practice location:
  • Phone: 443-204-5800
  • Fax:
Mailing address:
  • Phone: 443-204-5800
  • 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

VIII. Authorized Official

Name: DESIREE N MOUNTAIN
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 443-204-5800