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General NPI Number Information
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NPI Number | 1174246946
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Entity Type | Organization
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Legal Business Name | CAPITAL RECOVERY HEALTH LLC
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 04/05/2023
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Provider Practice Location Address
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Address Line | 130 PEMBROKE RD STE 100
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City | CONCORD
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State | NH
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Zip | 03301-5793
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Country | US
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Telephone | 781-389-5579
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Fax |
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Provider Business Mailing Address
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Address Line | 130 PEMBROKE RD STE 100
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City | CONCORD
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State | NH
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Zip | 03301-5793
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Country | US
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Telephone | 781-389-5579
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | RICHARD JUSTIN ETLING
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Credential |
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Telephone | 781-389-5579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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