Healthcare Provider Details

I. General information

NPI: 1013864750
Provider Name (Legal Business Name): HAGERSTOWN RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9055 SHADY GROVE CT
GAITHERSBURG MD
20877-1301
US

IV. Provider business mailing address

19120 MUNCASTER RD
DERWOOD MD
20855-2406
US

V. Phone/Fax

Practice location:
  • Phone: 301-355-7455
  • Fax: 240-489-6777
Mailing address:
  • Phone: 301-665-7940
  • Fax: 240-489-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRETT GOLDENBERG
Title or Position: DIRECTOR
Credential:
Phone: 301-665-7940