Healthcare Provider Details

I. General information

NPI: 1942964770
Provider Name (Legal Business Name): AWARE RECOVERY CARE OF VIRGINIA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 COX RD
GLEN ALLEN VA
23060-3395
US

IV. Provider business mailing address

35 THORPE AVE STE 104
WALLINGFORD CT
06492-1948
US

V. Phone/Fax

Practice location:
  • Phone: 203-779-5799
  • Fax:
Mailing address:
  • Phone: 203-779-5799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DONNA BENCE
Title or Position: VP REVENUE CYCLE MANAGEMENT
Credential:
Phone: 203-721-6522