Healthcare Provider Details

I. General information

NPI: 1174415103
Provider Name (Legal Business Name): RECOVERY FROM HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR # 5287
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

4210 ELECTRIC RD # 1039
ROANOKE VA
24018-0728
US

V. Phone/Fax

Practice location:
  • Phone: 973-358-2758
  • Fax:
Mailing address:
  • Phone: 838-732-6837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA KASSIM
Title or Position: CEO
Credential: MD
Phone: 838-732-6837