Healthcare Provider Details

I. General information

NPI: 1497331102
Provider Name (Legal Business Name): BEAR ISLAND RECOVERY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 CEDAR POINT BLVD
CEDAR POINT NC
28584-8022
US

IV. Provider business mailing address

722 CEDAR POINT BLVD PMB 242
CEDAR NC
28584
US

V. Phone/Fax

Practice location:
  • Phone: 828-273-1643
  • Fax:
Mailing address:
  • Phone: 828-273-1643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number
License Number State

VIII. Authorized Official

Name: DR. GRADY B JEFFERYS JR.
Title or Position: PRESIDENT & CEO
Credential: PHD
Phone: 828-273-1643