Healthcare Provider Details

I. General information

NPI: 1487961991
Provider Name (Legal Business Name): HOPE RECOVERYCENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 WASHINGTON ST.
LIMERICK ME
04048
US

IV. Provider business mailing address

147 WASHINGTON ST
LIMERICK ME
04048-3502
US

V. Phone/Fax

Practice location:
  • Phone: 207-793-4673
  • Fax:
Mailing address:
  • Phone: 207-793-4673
  • 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: RONALD D PETERSEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-793-4673