Healthcare Provider Details

I. General information

NPI: 1841070794
Provider Name (Legal Business Name): R3 RECOVERY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 COLUMBIA AVE
LANCASTER PA
17603-3633
US

IV. Provider business mailing address

618 COLUMBIA AVE
LANCASTER PA
17603-3633
US

V. Phone/Fax

Practice location:
  • Phone: 610-333-2186
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CALEB JOSEF MADISON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 610-333-2186