Healthcare Provider Details

I. General information

NPI: 1497593701
Provider Name (Legal Business Name): BEBOLD RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

957 W 21ST ST
NORFOLK VA
23517-1536
US

IV. Provider business mailing address

957 W 21ST ST
NORFOLK VA
23517-1536
US

V. Phone/Fax

Practice location:
  • Phone: 845-326-6160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ZVI PERSHNOWSKI
Title or Position: CEO/OWNER
Credential:
Phone: 845-326-6160