Healthcare Provider Details

I. General information

NPI: 1275272346
Provider Name (Legal Business Name): RECOVERY SOLUTIONS OF NORTHEAST OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2022
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 E 120TH ST
CLEVELAND OH
44106-1456
US

IV. Provider business mailing address

22639 EUCLID AVE
EUCLID OH
44117-1622
US

V. Phone/Fax

Practice location:
  • Phone: 216-404-1900
  • Fax:
Mailing address:
  • Phone: 216-404-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTINA S MOORE
Title or Position: EXECUITVE DIRECTOR
Credential: LPCC-S LICDC-CS CEAP
Phone: 216-404-1900