Healthcare Provider Details

I. General information

NPI: 1649584459
Provider Name (Legal Business Name): MERIDIAN RECOVERY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 SIGSBEE ST
ERIE PA
16508-1721
US

IV. Provider business mailing address

PO BOX 9471
ERIE PA
16505-8471
US

V. Phone/Fax

Practice location:
  • Phone: 814-746-2747
  • Fax: 814-833-1553
Mailing address:
  • Phone: 814-746-1447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS010329L
License Number StatePA

VIII. Authorized Official

Name: DR. CHRISTOPHER JOHN CARBO
Title or Position: PRESIDENT
Credential: D.O.
Phone: 814-746-1447