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General NPI Number Information
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NPI Number | 1104598036
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Entity Type | Organization
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Legal Business Name | CHOPTANK RECOVERY LLC
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Dates
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Enumeration Date | 09/29/2021
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 204 N MAIN ST
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City | GREENSBORO
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State | MD
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Zip | 21639-1453
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Country | US
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Telephone | 410-482-4089
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Fax |
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Provider Business Mailing Address
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Address Line | 5836 BEECHES DR
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City | PRESTON
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State | MD
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Zip | 21655-2108
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Country | US
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Telephone | 410-562-7711
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | MR. JEREMY SAVIN
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Credential |
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Telephone | 410-562-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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