=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275397515
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEN'S RECOVERY HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2024
-----------------------------------------------------
Last Update Date | 12/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 365 EAST ST BLDG 34
-----------------------------------------------------
City | TEWKSBURY
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01876-1950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-459-8658
-----------------------------------------------------
Fax | 978-937-2559
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 JACKSON ST 4TH FLOOR
-----------------------------------------------------
City | LOWELL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01852-2103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-459-8658
-----------------------------------------------------
Fax | 978-937-2559
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING & CREDENTIALING ANALYST
-----------------------------------------------------
Name | LITMARIE REYES MELENDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 978-788-8879
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------