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General NPI Number Information
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NPI Number | 1003473646
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Entity Type | Organization
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Legal Business Name | RECOVERY & WELLNESS CENTER, LLC.
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Dates
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Enumeration Date | 05/20/2019
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 218 LORRAINE AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07043-1915
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Country | US
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Telephone | 917-751-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 605 GROVE ST APT D1
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City | CLIFTON
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State | NJ
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Zip | 07013-3867
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Country | US
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Telephone | 917-751-8700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIANE DECAROLIS
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Credential | APN
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Telephone | 917-751-8700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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