Healthcare Provider Details

I. General information

NPI: 1942880232
Provider Name (Legal Business Name): RECOVER COLLABORATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2021
Last Update Date: 04/11/2021
Certification Date: 04/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 KERRY PARK
PITTSFORD NY
14534-2613
US

IV. Provider business mailing address

23 KERRY PARK
PITTSFORD NY
14534-2613
US

V. Phone/Fax

Practice location:
  • Phone: 585-698-8694
  • Fax:
Mailing address:
  • Phone: 585-698-8694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIC GRILLS
Title or Position: DIRECTOR OF BILLING AND FINANCE
Credential:
Phone: 585-698-8694