Healthcare Provider Details

I. General information

NPI: 1770027286
Provider Name (Legal Business Name): AWARE RECOVERY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CONSTITUTION DR SUITE 2N
BEDFORD NH
03110-6042
US

IV. Provider business mailing address

556 WASHINGTON AVE UNIT 201
NORTH HAVEN CT
06473-1149
US

V. Phone/Fax

Practice location:
  • Phone: 203-779-5799
  • Fax:
Mailing address:
  • Phone: 860-899-6685
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW EACOTT
Title or Position: VICE PRESIDENT, OFFICER
Credential:
Phone: 203-779-5799