Healthcare Provider Details

I. General information

NPI: 1922051242
Provider Name (Legal Business Name): RECOVERY HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 CHURCH ST
WALLINGFORD VT
05773-9650
US

IV. Provider business mailing address

PO BOX 207
WALLINGFORD VT
05773-0207
US

V. Phone/Fax

Practice location:
  • Phone: 802-446-2640
  • Fax: 802-446-2636
Mailing address:
  • Phone: 802-446-2640
  • Fax: 802-446-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE M FITZSIMMONS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 802-446-2640