Healthcare Provider Details

I. General information

NPI: 1417546987
Provider Name (Legal Business Name): REVCORE RECOVERY CENTER OF MANHATTAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 BROADWAY FL 4
NEW YORK NY
10013-6023
US

IV. Provider business mailing address

394 BROADWAY FL 4
NEW YORK NY
10013-6023
US

V. Phone/Fax

Practice location:
  • Phone: 917-743-6302
  • Fax:
Mailing address:
  • Phone: 212-966-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AVRAHAM SCHICK
Title or Position: CEO
Credential:
Phone: 212-966-9537