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General NPI Number Information
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NPI Number | 1225920408
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Entity Type | Organization
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Legal Business Name | LOST SOULS RECOVERY, LLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 130 WHITE HORSE PIKE
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City | CLEMENTON
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State | NJ
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Zip | 08021-4159
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Country | US
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Telephone | 570-622-9101
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Fax | 570-622-9102
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Provider Business Mailing Address
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Address Line | 130 WHITE HORSE PIKE
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City | CLEMENTON
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State | NJ
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Zip | 08021-4159
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Country | US
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Telephone | 570-622-9101
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Fax | 570-622-9102
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Authorized Official
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Title or Position | CEO
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Name | NADEEM BASHIR
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Credential |
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Telephone | 570-622-9101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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