Healthcare Provider Details

I. General information

NPI: 1326136672
Provider Name (Legal Business Name): RECOVERY ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 PORTLAND RD
KENNEBUNK ME
04043-6658
US

IV. Provider business mailing address

62 PORTLAND RD
KENNEBUNK ME
04043-6658
US

V. Phone/Fax

Practice location:
  • Phone: 207-985-8900
  • Fax:
Mailing address:
  • Phone: 207-985-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number403531
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierRQ5
Identifier TypeOTHER
Identifier StateME
Identifier IssuerANTHEM PROVIDER ID

VIII. Authorized Official

Name: MICHAEL BEAN
Title or Position: EXECUTIVE DIRECTOR
Credential: LCPC, LADC
Phone: 207-985-8900