Healthcare Provider Details

I. General information

NPI: 1194246371
Provider Name (Legal Business Name): BODHI RECOVERY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 YOST BLVD COST COMMONS #5 SUITE 301
PITTSBURGH PA
15221-5283
US

IV. Provider business mailing address

21 YOST BLVD COST COMMONS #5 SUITE 301
PITTSBURGH PA
15221-5283
US

V. Phone/Fax

Practice location:
  • Phone: 412-735-9197
  • Fax: 412-291-2765
Mailing address:
  • Phone: 412-735-9197
  • Fax: 412-291-2765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CAROLE GENE STERN
Title or Position: CEO/PRESIDENT
Credential: RN-BC, LICENSED PSYC
Phone: 724-322-2229