Healthcare Provider Details

I. General information

NPI: 1356193296
Provider Name (Legal Business Name): BEBOLD RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
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: 757-586-4392
  • Fax:
Mailing address:
  • Phone: 757-586-4392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK FISHMAN
Title or Position: OWNER
Credential:
Phone: 757-586-4392