Healthcare Provider Details

I. General information

NPI: 1396389565
Provider Name (Legal Business Name): RECOVERY HEALTH SOLUTIONS IPA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 36TH ST
NEW YORK NY
10018-6404
US

IV. Provider business mailing address

315 W 36TH ST
NEW YORK NY
10018-6404
US

V. Phone/Fax

Practice location:
  • Phone: 716-208-4664
  • Fax:
Mailing address:
  • Phone: 716-208-4664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CAROL CASSELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 716-208-4664