Healthcare Provider Details

I. General information

NPI: 1609708072
Provider Name (Legal Business Name): BEBOLD RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 N MECKLENBURG AVE
SOUTH HILL VA
23970-2022
US

IV. Provider business mailing address

409 N MECKLENBURG AVE
SOUTH HILL VA
23970-2022
US

V. Phone/Fax

Practice location:
  • Phone: 757-586-4392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: ZVI ELIMELECH PRUSHINOVSKY
Title or Position: OWNER
Credential:
Phone: 845-326-6160