Healthcare Provider Details

I. General information

NPI: 1841769957
Provider Name (Legal Business Name): RECOVERY CONNECTION MEDICAL SERVICES OF AMERICA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2018
Last Update Date: 11/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 WICKENDEN ST
PROVIDENCE RI
02903-4425
US

IV. Provider business mailing address

381 WICKENDEN ST
PROVIDENCE RI
02903-4425
US

V. Phone/Fax

Practice location:
  • Phone: 877-557-3155
  • Fax: 401-490-0905
Mailing address:
  • Phone: 877-557-3155
  • Fax: 401-490-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: REGIS BURLAS
Title or Position: PRESIDENT
Credential: DO
Phone: 401-433-7550