Healthcare Provider Details

I. General information

NPI: 1225804552
Provider Name (Legal Business Name): SOUTHERN MAINE RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 CUMBERLAND ST
WESTBROOK ME
04092-3045
US

IV. Provider business mailing address

271 CUMBERLAND ST
WESTBROOK ME
04092-3045
US

V. Phone/Fax

Practice location:
  • Phone: 781-367-4650
  • Fax:
Mailing address:
  • Phone: 207-494-4114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JOHN BURO
Title or Position: MANAGER
Credential: LADC
Phone: 781-367-4650