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General NPI Number Information
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NPI Number | 1225804552
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Entity Type | Organization
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Legal Business Name | SOUTHERN MAINE RECOVERY LLC
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Dates
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Enumeration Date | 11/28/2023
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 271 CUMBERLAND ST
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City | WESTBROOK
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State | ME
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Zip | 04092-3045
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Country | US
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Telephone | 781-367-4650
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Fax |
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Provider Business Mailing Address
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Address Line | 271 CUMBERLAND ST
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City | WESTBROOK
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State | ME
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Zip | 04092-3045
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Country | US
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Telephone | 207-494-4114
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JOHN BURO
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Credential | LADC
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Telephone | 781-367-4650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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