Healthcare Provider Details

I. General information

NPI: 1124516349
Provider Name (Legal Business Name): RECOVERY CONNECTION CENTERS OF AMERICA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 02/24/2020
Certification Date: 02/24/2020
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: 401-439-7785
  • Fax:
Mailing address:
  • Phone: 401-439-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL BRIER
Title or Position: MANAGER
Credential:
Phone: 401-439-7785